Might 8, 2023 — The antibiotic doxycycline reduces the onset of HIV and sexually transmitted infections (STIs) by two-thirds after publicity, in line with analysis sponsored by the Nationwide Institutes of Well being.
The analysis aimed to floor earlier case research of doxycycline in a medical trial of males who’ve intercourse with males, mentioned lead researcher Anne Luetkemeyer, MD, an infectious illness specialist with the College of California, San Francisco, and an affiliate with a number of Bay Space hospitals.
Earlier analysis from France in 2016 appeared to point out that doxycycline – or doxy – labored in opposition to sexually transmitted ailments. However Luetkemeyer’s staff needed to substantiate these findings and research its results in a distinct inhabitants, she mentioned.
This randomized, managed trial discovered doxycycline diminished incidence of sexually transmitted infections equivalent to chlamydia and syphilis. Males assigned male at beginning demonstrated the advantages of the two-thirds fee of prevention. A 2022 research involving girls in Kenya confirmed restricted to no prevention with doxycycline.
Doxycycline is an antibiotic within the tetracycline class. Like all antibiotics, it stops or slows bacterial infections however not viral ones. Doxycycline is used to deal with anthrax, malaria, zits, and different situations. A prescription for the antibiotic prices solely pennies when you’ve got insurance coverage.
The analysis revealed in April within the New England Journal of Drugs reveals the broader software of doxycycline in lowering HIV and STIs in males who’ve intercourse males and in trans girls.
“How we have now been speaking about it [doxycycline] amongst sufferers is: Consider it as a morning-after tablet, however for STIs,” mentioned Aniruddha Hazra, MD, who focuses on infectious illness at College of Chicago Drugs Infectious Illness and International Well being unit and was not concerned with the research. “So whereas a morning-after tablet is usually a prophylaxis (or prevention) in opposition to being pregnant, doxycycline can be utilized shortly after sexual contact or potential publicity with an STI to stop acquisition of an an infection.”
The 2023 federally funded research reveals that research members, who reported having a sexually transmitted an infection up to now 12 months, diminished their threat of renewed an infection by two-thirds with the safety of the antibiotic.
The research, led by researchers on the College of California, San Francisco, and the College of Washington, enrolled about 500 adults from 4 clinic websites in San Francisco and Seattle. All of the research members had been assigned male at beginning, reported sexual exercise, and had a historical past of STI or HIV prognosis.
The trial discovered that 10.7% of sufferers who took doxycycline had a STI prognosis in comparison with 31.9% of the management group — a two-thirds discount in STI instances. The HIV prognosis for doxycycline sufferers was 11.8% vs. 30.5% within the management – once more a virtually two-thirds discount.
Although there have been no experiences of doxycycline-resistance within the chlamydia or syphilis instances, Luetkemeyer mentioned researchers are strains of doxy-PrEP for individuals who have developed breakthrough infections to search for proof of resistance.
“We definitely have to be vigilant about that risk,” Luetkemeyer mentioned. “But it surely simply has not been described but. And positively, quite a lot of syphilis and quite a lot of chlamydia have been handled with doxycycline thus far.”
Trevor Hedberg, a doctor assistant and head of the Sexual and Reproductive Well being Stroll-In Clinic at Howard Brown Well being in Chicago, mentioned two sufferers have introduced up doxy as a pre-exposure therapy up to now 6 months. He mentioned the clinic often advocate doxycycline for individuals assigned male at beginning who do intercourse work or who’ve had a syphilis diagnoses up to now.
“So, you recognize, the way in which I method the conversations round doxy PrEP is predicated on STI historical past,” Hedberg mentioned. “How the affected person perceives their threat of publicity to STI is, and going over the uncomfortable side effects and the protection profile of doxycycline and whether or not it is one thing that they really feel comfy taking.”
Folks have been extra accepting of utilizing doxy for pre-exposure safety through the years, and the primary concern is on antibiotic resistance, mentioned Zach Chook, a well being educator at Heart on Halsted, a group heart devoted to the well being of LGBTQ+ individuals within the Chicago space.
“I do see why there is a want for the analysis on doxy as a result of there’s been extra recorded instances of bacterial STIs going round and syphilis,” Chook mentioned.
At first, “lots of people had been shaming individuals who had been taking [doxy] PrEP to have the ability to entry extra intercourse. I do not actually see that occuring, at the very least in the neighborhood that I serve,” Chook mentioned. “However the those that I’ve heard from have extra of the like: You do not know if there’s going to construct a resistance, are we going to have tremendous gonorrhea or one thing over time.”
The discount of STI and HIV by means of doxycycline is generally relevant to those that are assigned male at beginning.
“I might say that within the interim, till we have now extra info in cisgender girls, that is not a inhabitants for whom doxy PrEP is really helpful,” Luetkemeyer mentioned. “I might additionally say this actually is not an intervention for the overall inhabitants but.”
Hazra mentioned doxycycline is without doubt one of the most generally prescribed outpatient antibiotics throughout the final 5 years after the ANRS analysis in France. Nonetheless, he suggested in opposition to prescription for people who find themselves pregnant due to tetracycline’s potential threat of beginning defects together with discoloration of enamel and abnormality within the bones.
CDC has launched concerns of doxycycline prescription however not detailed steering. The San Francisco Division of Public Well being, the place Luetkemeyer practices, has launched suggestions for cisgender males and trans girls.
Males who’ve intercourse with males are one group most in danger to be disproportionately impacted by HIV. In keeping with the CDC, the lifetime threat for HIV an infection amongst MSM is 1 in 6 in comparison with one in 524 for heterosexual males or one in 253 for heterosexual girls.
“I believe [doxy PrEP] is a very good instrument within the toolbox for individuals who want extra STI prevention measures, and the way in which we have a look at it’s to attempt to provide this to people who find themselves carrying the very best threat,” Luetkemeyer mentioned.