CDC recommends PEP for bacterial STIs, which are becoming increasingly resistant to antibiotics
|Published
The Centres for Disease Control and Prevention (CDC) shared new guidelines earlier this week to help fight the rise of sexually transmitted infections (STIs).
These guidelines advise using a preventive antibiotic called doxycycline post-exposure prophylaxis (doxy-PEP) to stop syphilis, gonorrhoea and chlamydia.
The CDC recommends that doctors talk to gay, bisexual and other men who have sex with men (MSM) and transgender women (TGW) who've had at least one bacterial STI in the last 12 months about using doxy-PEP.
The CDC suggests offering doxy-PEP along with other sexual health measures like counselling, STI screening and treatment, vaccines, and help with HIV prevention and care.
CDC's Jonathan Mermin, MD, MPH, who is the director of the National Centre for HIV, Viral Hepatitis, STD, and TB Prevention, emphasised the importance of a new STI prevention tool called doxy-PEP, especially in light of the urgent need for innovation in STI prevention.
Multiple studies have shown doxycycline's safety and effectiveness in preventing bacterial STIs, according to the guidelines developed by the CDC.
The doxy-PEP trial conducted among MSM men and transgender women in San Francisco and Seattle showed promising results.
Taking 200mg of doxycycline within 72 hours of unprotected sex reduced the incidence of chlamydia, syphilis and gonorrhoea by significant percentages.
While the trials showed positive outcomes among MSM and TGW, a trial among cisgender women didn't yield significant results. However, recommending doxy-PEP for MSM and TGW with a recent history of bacterial STIs could potentially prevent up to 42% of STIs, according to one study.
The need for innovation in STI prevention is evident as STI rates continue to rise, with over 2.5 million cases reported in 2022 alone, the CDC reported.
Despite efforts, STI rates have shown no signs of decline, highlighting the importance of new prevention strategies like doxy-PEP.
Sexually transmitted diseases (STDs) like gonorrhoea are becoming increasingly difficult to treat due to antibiotic resistance, according to the CDC.
Gonorrhoea is one of three diseases labelled as "urgent threats" by the CDC because many of the antibiotics once used to treat it no longer work. Syphilis and chlamydia are also showing early signs of antibiotic resistance.
Last year, the World Health Organisation (WHO) released new guidelines for treating these STDs due to the rapid increase in drug resistance, which has limited treatment options.
While the introduction of doxy-PEP offers hope in reducing bacterial STIs, Mermin stresses that it's not a cure-all solution.
However, if implemented equitably and thoughtfully, it could significantly reduce the toll of STIs, especially among populations most affected by these infections.
Despite its potential benefits, concerns remain about the long-term impact of doxy-PEP on antibiotic resistance. There are questions about whether its expanded use could lead to multidrug resistance in pathogens like Neisseria gonorrhoeae and affect the microbiome.
The CDC acknowledges these concerns and plans to monitor the uptake of doxy-PEP, its impact on STI rates and trends in antimicrobial resistance. As new data becomes available, the agency will adjust its recommendations accordingly.