Public health officials are deploying a potent new tool in the battle against rising sexually transmitted infections: a common antibiotic that functions as a morning-after pill.
It is the latest advancement as the sexual health field shifts to preventive medicine — not just condoms, abstinence and tests — as the best hope for suppressing the pathogens that can spread during sex.
For the past decade, individuals have been able to engage in unprotected sex with a low risk of contracting HIV thanks to daily pills known as PrEP, or pre-exposure prophylaxis. However, they were still vulnerable to bacterial infections, including the recent surge in syphilis, gonorrhea, and chlamydia — until now.
Recent studies indicate that the antibiotic doxycycline, taken after sexual encounters, serves as a post-exposure prophylaxis to prevent those infections. Nevertheless, experts are also concerned about unintended consequences. The Centers for Disease Control and Prevention plans to release guidelines later this summer for implementing the treatment, known as DoxyPEP, in hopes of addressing fears among medical professionals that preventive use would contribute to antibiotic resistance — and the emergence of drug-resistant superbugs.
“It’s the first significant intervention we’ve had for STIs since the vaccine for human papillomavirus” nearly two decades ago, said Jonathan Mermin, who leads STI prevention for the CDC. “But it is a new intervention, and because of that, there are potential benefits and potential risks.”
Doctors, public health officials, and sexual health clinics have embraced preventive pills as a practical way to curb STIs because they preserve pleasure while safeguarding partners. Some doctors have started prescribing it to a specific subset of the gay community considered at heightened risk for STIs.
“Just like PrEP was a game changer, this empowers individuals to make choices about their sexual health,” said Jorge Roman, senior director of clinical services at the San Francisco AIDS Foundation, one of the first to widely distribute DoxyPEP. “It doesn’t always have to be about condoms.”
Doxycycline is already used as a primary antibiotic treatment for chlamydia and occasionally for syphilis and gonorrhea. However, its use for prevention has raised concerns that it would no longer be effective in patients who use it regularly and that it may facilitate the development of antibiotic-resistant strains of the pathogens.
While DoxyPEP has shown promising results in reducing STIs, researchers are also examining whether its use could lead to antibiotic resistance. The study conducted in the United States found a slight increase in antibacterial resistance among participants using DoxyPEP. The authors of the study emphasized that this finding should be considered in the context of doctors administering fewer antibiotics overall.
Antibiotic resistance is a growing concern globally, as bacteria evolve and become resistant to commonly used antibiotics. If DoxyPEP becomes a widely used preventive treatment for STIs, there is a possibility that it could contribute to the development of antibiotic-resistant strains of bacteria. This would have significant implications for public health and the effectiveness of future treatments.
Researchers studying DoxyPEP are closely monitoring this potential risk and believe that long-term attention should be given to understanding the impact of the treatment on antibacterial resistance. It is crucial to strike a balance between preventing STIs and ensuring the responsible use of antibiotics to combat bacterial infections.
In conclusion, DoxyPEP has shown promise in reducing STIs among certain populations, such as transgender women and men who have sex with men. However, its effectiveness among cisgender women and its potential impact on antibiotic resistance require further research. As with any new treatment, it is essential to carefully evaluate its benefits and risks to inform public health strategies effectively.
