Doxycycline Prophylaxis for Bacterial Sexually Transmitted Infections

Juliana S Grant; Chrysovalantis Stafylis; Connie Celum; Troy Grennan; Bridget Haire; John Kaldor; Anne F Luetkemeyer; John M Saunders; Jean-Michel Molina; Jeffrey D Klausner

doi:10.1093/cid/ciz866

Doxycycline Prophylaxis for Bacterial Sexually Transmitted Infections

Clin Infect Dis. 2020 Mar 3;70(6):1247-1253. doi: 10.1093/cid/ciz866.

Authors

Juliana S Grant¹, Chrysovalantis Stafylis², Connie Celum^{3

4

5}, Troy Grennan⁶, Bridget Haire⁷, John Kaldor⁷, Anne F Luetkemeyer⁸, John M Saunders⁹, Jean-Michel Molina^{10

11}, Jeffrey D Klausner^{2

12

13}

Affiliations

¹ JSG Health, LLC, Seattle, Washington DC, USA.
² Division of Infectious Diseases, University of California-Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, California, USA.
³ Department of Global Health, University of Washington, Seattle, Washington DC, USA.
⁴ Department of Medicine, University of Washington, Seattle, Washington DC, USA.
⁵ Department of Epidemiology, University of Washington, Seattle, Washington DC, USA.
⁶ British Columbia Centre for Disease Control and Division of Infectious Diseases, University of British Columbia, Vancouver, Canada.
⁷ The Kirby Institute, University of New South Wales, Sydney, Australia.
⁸ Zuckerberg San Francisco General, University of California, San Francisco, California, USA.
⁹ Blood Safety, Hepatitis, STI, and HIV Division, National Infection Service, Public Health England, London, United Kingdom.
¹⁰ Department of Infectious Diseases, St-Louis Hospital, University of Paris Diderot, Paris, France.
¹¹ INSERM U944, Paris, France.
¹² Department of Epidemiology, University of California-Los Angeles (UCLA), Los Angeles, California, USA.
¹³ Fielding School of Public Health, University of California-Los Angeles (UCLA), Los Angeles, California, USA.

Abstract

Bacterial sexually transmitted infections (STIs) have been increasing over the past 2 decades in gay, bisexual, and other men who have sex with men. With the widespread use of early human immunodeficiency virus (HIV) treatment, which virtually eliminates transmission risk, and the availability of HIV pre-exposure prophylaxis, there have been attitudinal changes regarding HIV infection with resultant increases in sexual contact and declines in condom use. Doxycycline is used for primary prophylaxis in a number of infectious diseases. We conducted a state-of-the-art review to examine the current state of research, knowledge gaps, and challenges around the use of doxycycline prophylaxis to prevent syphilis and other STIs. International academic and government experts met in March 2019 to frame the initial inquiry, which was supplemented by focused literature searches. Two small short-term randomized controlled trials examining doxycycline prophylaxis found high efficacy. Five additional clinical studies are underway or in development. Studies differed in design, population, outcomes, and safety measures. Doxycycline prophylaxis for bacterial STIs shows promise. Better and more robust data are needed on efficacy; target population; community acceptability; behavioral risk compensation; doxycycline dose, regimen, and formulation; long-term safety; antimicrobial resistance; cost-effectiveness; and risk-benefit.

Keywords: chlamydia; doxycycline; men who have sex with men; prophylaxis; syphilis.

Publication types

Research Support, N.I.H., Extramural
Review

MeSH terms

Doxycycline / therapeutic use
HIV Infections* / drug therapy
HIV Infections* / prevention & control
Homosexuality, Male
Humans
Male
Pre-Exposure Prophylaxis*
Sexual and Gender Minorities*
Sexually Transmitted Diseases* / drug therapy
Sexually Transmitted Diseases* / prevention & control

Substances

Doxycycline

Abstract

Publication types

MeSH terms

Substances

Grants and funding