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Doxycycline prophylaxis promising for bacterial STI prevention
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Findings from a state-of-the-art review showed that doxycycline prophylaxis may be a promising strategy to prevent bacterial STIs.
“The United States is currently experiencing the worst STD epidemic in more than a generation,” Jeffrey D. Klausner, MD, MPH, professor in the division of infectious diseases and department of epidemiology at the UCLA David Geffen School of Medicine and Fielding School of Public Health, told Infectious Disease News. “Rates of syphilis are among the highest in 25 years. We urgently need new approaches and strategies to control STDs. The use of doxycycline prophylaxis in core group members could be an important STD control strategy.”
Over the past 2 decades, the incidence of bacterial STIs among men who have sex with men (MSM) have been increasing, driven in part by widespread use of early HIV treatment and pre-exposure prophylaxis (PrEP) creating “attitudinal changes” regarding sexual contact and condom use, Klausner and colleagues wrote.
The aim of their review was to examine the current state of research, knowledge gaps and challenges associated with doxycycline prophylaxis for the prevention of STIs. The review found two small, short-term, randomized control trials that demonstrated high efficacy of doxycycline prophylaxis. Additionally, the researchers reported that five clinical studies are underway or in development to examine the efficacy and safety of doxycycline prophylaxis, and that the studies have different designs, populations, outcomes and safety measures.
According to the researchers, improved and more robust data are needed. They suggested focusing on efficacy; target populations; community acceptability; behavioral risk compensation; doxycycline dose, regimen and formulation; long-term safety; antimicrobial resistance; cost-effectiveness; and risk-benefit ratio.
“Doxycycline prophylaxis might be very effective at preventing syphilis and chlamydia in high-risk people,” Klausner said. “More research on the best way to use doxycycline — daily or as a single dose after sex; community acceptability; on its impact on the microbiome and antimicrobial resistance; and how to implement it as a STD control strategy [is needed].” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Amesh A. Adalja, MD
The use of PrEP has revolutionized the response to HIV. If this success can be replicated for other STIs — which are on a major upswing — it would be a major win in the battle against these infections. Although the evidence base is not strong, there is an important positive signal that needs to be studied more systematically to demonstrate benefit and assess the risk of antimicrobial resistance with widespread use of antibiotic-based therapies. However, it may be a feasible strategy in high-risk populations if coupled to surveillance for resistance among targeted infections. STIs such as gonorrhea, chlamydia, and syphilis have slipped out of control and having an effective pharmaceutical preventive measure could significantly diminish the force of infection and reverse the worrying trend currently occurring.
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