The United States will soon launch a powerful weapon in its long-running fight against sexually transmitted diseases: an old antibiotic that has been repurposed into a preventative tablet.
DoxyPEP or doxycycline taken as a pre-exposure prophylaxis after condomless sex has been found by researchers to be a significant way of reducing the risk for chlamydia.
The Center for Disease Control and Prevention, which is developing national guidelines for clinicians will have to weigh up the need to contain STIs that are at record levels and impact millions of Americans against the potential for more antibiotic-resistant strains.
Jonathan Mermin, a senior CDC Official, told AFP: “Innovation and creative thinking are essential in public healthcare. More tools are needed urgently.”
The recommendations set to be published in the summer will have a limited scope.
The vaccines will probably only target the highest-risk gay men and transgender females with a history of previous infection.
Some clinics have already prescribed DoxyPEP as the word spreads.
Malik, a 37-year-old man in Washington, said his doctor recently told him he could start using doxycycline as a “morning-after pill” following risky sex, something he’s had to do twice – including after a partner did not warn him he had removed his condom.
Two-thirds discount
After a decade-long increase, the United States reported 2.5 million cases of three bacterial diseases in 2021.
Several issues are behind the rise: fewer people are using condoms since the advent of PrEP – daily pills that significantly reduce chances of contracting HIV.
People who take PrEP should be screened every three months to increase the likelihood of detecting infections.
There is also the epidemiological fact, that the larger the number of infected people are, the more they spread.
Researchers found DoxyPEP effective in three out of four trials.
Annie Luetkemeyer said, “We saw a 2/3 reduction in sexually-transmitted infections every 3 months.” Co-led an American trialAFP reported that.
The physician-scientist from the University of California San Francisco recruited 500 men in San Francisco and Seattle who had sex with transgender men or women.
For gonorrhea and chlamydia the effectiveness was highest, with both reducing by approximately 80 percent. The side effects were minimal.
Antibiotic resistance
The increased availability of doxycycline, especially in the rapidly mutating gonorrhea strain, has raised concerns over antibiotic resistance.
Early research does not indicate cause for alarm.
Connie Celum of University of Washington who led the US study told AFP that researchers compared gonorrhea samples of breakthrough infections from the DoxyPEP groups to the group that didn’t get the pill.
Although they found that the rate of resistant gonorrhea was slightly higher in DoxyPEP, she believes the finding could mean the pill is simply less effective against strains already resistant, and does not cause this resistance.
DoxyPEP could even boost responsible antibiotic stewardship – cutting the incidence of infections, thus also cutting need for antibiotic treatment.
Ceftriaxone is the frontline antibiotic that doctors want to keep. If it were to reduce gonorrhea by 50 percent, the number of patients who need antibiotics would be reduced.
It is necessary to study the impact of STIs and “bystander” bacteria, such as Staphylococcus aureus, which live inside people’s noses but sometimes cause serious infections.
‘Additional tool’
Malik stated that he was glad to be able to use DoxyPEP in a desperate situation, but he wished more men would use condoms. Malik has found that since he moved to America from South Asia he receives relatively little interest when he states he is not willing to engage in condomless sexual activity on the dating application Grindr.
But Stephen Abbott – a doctor at Washington’s Whitman-Walker clinic who prescribes and uses DoxyPEP – said it’s crucial to meet people where they are.
“From speaking with patients, and being part of the community that’s now on PrEP… I think the age of prevention through condoms is fading,” he told AFP.
A 42-year old man who runs a culture organization in London told AFP the word about DoxyPEP had spread through the gay party circuit internationally. He had purchased a supply of the drug on the black market, and via a partner in Mexico who purchases in bulk.
He had mostly gotten better, but he did get a breakthrough throat infection. He expressed his hope that the United Kingdom would adopt similar guidelines so people could have the correct information and not be left guessing at the dosage.
Luetkemeyer doesn’t believe DoxyPEP will be the “answer” for the STI The epidemic is spreading. And there is great interest in the development a gonorrhea virus.
“But I’m optimistic… I think this is an additional tool,” she said.
