Doxycycline post-exposure prophylaxis for sexually transmitted infections in South Africa

Southern African Journal of HIV Medicine

Field Value
Title Doxycycline post-exposure prophylaxis for sexually transmitted infections in South Africa
Creator Peters, Remco P.H. McIntyre, James A. Garrett, Nigel Brink, Adrian J. Celum, Connie L. Bekker, Linda-Gail
Subject Medicine; Infectious Diseases; Sexually transmitted infections doxycycline; STI prevention; men who have sex with men; antimicrobial resistance; Chlamydia trachomatis; Neisseria gonorrhoeae; syphilis
Description South Africa has a large burden of bacterial sexually transmitted infections (STIs) with high rates among men who have sex with men (MSM). Randomised controlled trials have recently demonstrated high effectiveness of doxycycline post-exposure prophylaxis (PEP) for prevention of bacterial STIs in MSM, with 70% – 85% reductions in Chlamydia trachomatis infection and syphilis, and approximately 50% reduction in Neisseria gonorrhoeae infection. Doxycycline PEP was not demonstrated to be effective in reducing C. trachomatis and N. gonorrhoeae infection among Kenyan cisgender women. Although no worrisome trends in antimicrobial resistance (AMR) were observed in the trials, important concerns remain about doxycycline PEP and AMR development in STIs, other pathogens, commensals, and the microbiome. Tetracycline resistance in N. gonorrhoeae is already widespread in South Africa, but emergence of AMR in other STIs would be concerning. Larger sample sizes of doxycycline PEP users with longer follow-up time are needed to understand the impact that doxycycline PEP may have on AMR at individual and population level. In this opinion article, we weigh the benefits of doxycycline PEP for prevention of bacterial STIs against the existing AMR concerns and data gaps in the South African context. Based on the current evidence, we conclude that it would be reasonable to offer doxycycline PEP to high-risk MSM on a case-by-case basis, provided that it is offered by experienced sexual health clinicians in settings that have access to diagnostic STI testing and ongoing AMR surveillance.
Publisher AOSIS
Date 2023-09-28
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — Opinion paper; view point
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajhivmed.v24i1.1510
Source Southern African Journal of HIV Medicine; Vol 24, No 1 (2023); 6 pages 2078-6751 1608-9693
Language eng
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Coverage South Africa Current Population
Rights Copyright (c) 2023 Remco P.H. Peters, James A. McIntyre, Nigel Garett, Adrian J Brink, Connie L Celum, Linda-Gail Bekker