Some of the GBHSH men’s community consider doxycycline a means of preventing sexually transmitted diseases.

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The increasing incidence of bacterial sexually transmitted infections is a major public health problem worldwide. Among the treatments currently being studied is the use of the antibiotic doxycycline as a method of prevention after unprotected sex, known as DoxyPEP. Now the University of Barcelona and the NGO Stop have carried out the first study in Spain on the use of the DoxyPEP method as a prevention strategy among a community of gay, bisexual and other men who have sex with men (GBMSH) in Spain. state Spanish.

“The results show that although medical and scientific associations rarely endorse the use of DoxyPEP in the community as a preventive strategy, the GBHSH community is already using it as a preventative measure,” explains Sergio Villanueva, who led the study and is a professor in the Department of Information and Audiovisual Media and Researcher at the Center for Research in Information, Communication and Culture of the UB (CRIIC). The work, published in the journal Infection, was supported by Stop, a non-governmental organization dedicated to community sexual health GBHSH, of which Professor Villanueva is a member.

DoxyPEP is a promising tool, but comes with the risk of increasing bacterial resistance.

Various clinical studies in recent years, such as the IPERGAY clinical trial in France in 2015; DoxyPEP in the US or DoxyVac in France in 2022 evaluated the effectiveness of doxycycline as a post-exposure prophylaxis method, known as DoxyPEP, with promising results against syphilis (Treponema pallidum), chlamydia (Chlamydia trachomatis) and, to a lesser extent, gonorrhea (Neisseria gonorrhoeae). Despite these data, most medical and scientific associations do not recommend its use in public settings, especially due to concerns about the potential impact of this therapy on increasing antibiotic resistance.

The researchers explain that “The European AIDS Clinical Society (EACS) indicates that DoxyPEP may be offered to people with recurrent sexually transmitted infections (STIs) who are living with the human immunodeficiency virus (HIV), and only on an individual basis. Following these recommendations, several national associations in European countries have issued similar recommendations, such as the Spanish Association of Infectious Diseases and Clinical Microbiology (SEIMC), which recommends DoxyPEP only in certain cases.

The data are consistent with studies in other countries.

In this context, experts have attempted to provide an overview of the penetration of this pharmacological tool into the GBHSH community. To this end, they interviewed 150 people from the group through the NGO’s social networks. The results showed that 35.4% of respondents used doxycycline as DoxyPEP, 17.2% of whom did not follow the administration recommendations assessed in clinical trials, i.e. 200 mg every seventy-two hours after sex without a condom.

These results should be interpreted with caution because they are based on self-reported data and important factors such as duration or adherence to DoxyPEP were not adequately captured in the survey.

Villanueva acknowledges that “these results are consistent with those obtained in a similar study conducted in Germany, in which a comparable proportion of members of the GBHSH community sample had taken doxycycline in the past year and used it as DoxyPEP (35.4% vs. 23). %)”. As for the most common ways to obtain doxycycline, the most common methods, according to the study, are a prescription from a specialist or using pills left over from a previous treatment; In some cases, they also obtain it by ordering online or through unofficial channels.

In addition, the study also found that use of DoxyPEP was associated with a reduction in past-year diagnoses of diseases such as syphilis and gonorrhea, but only significantly for chlamydia. However, the researchers stress that these results should be interpreted “with caution as they are based on self-reported data and important factors such as duration or adherence to DoxyPEP were not adequately captured in the survey.”

Need for regulation and guidance for safe use of DoxyPEP

In any case, according to the researchers, “a lack of regulation and decision-making may lead to, on the one hand, the misuse of doxycycline as a preventive strategy in treatment regimens that are not based on strong evidence, and, on the other hand, the acquisition of the drug through unregulated channels.” or providing false information to health care providers.

In this sense, the authors emphasize the need for “a medical and scientific discourse that, in collaboration with civil society organizations involved in sexual health, formulates systematic and evidence-based recommendations for this preventive tool in order to “guarantee the quality of treatment.” and training of specialists responsible for their appointment.”