Thread by @JncherabieMD

SUPER excited for this panel this AM! Stay tuned for updates on Doxy PEP!! #STDConf22

Amazing results with Doxy PEP, 65% reduction in STIs per quarter, 55-57% reduction in GC, 74-88% reduction in CT, and 87% reduction in syphilis (only significant among PrEP but not much baseline syphilis)

Participants typically took 16 doses per month based on pill count, majority took <10 doses/month. No change in sex partners, condoles sex, or risk compensation.

Gonococcal Tetracycline susceptibility - baseline 25% TCN resistance, but still saw results which is interesting. Still would resistance increase with more Doxy PEP use?? More research needed

Now how will Doxy PEP affect the microbiome??
MSM who have receptive anal sex have enriched Prevotella microbiome, lube also affects microbiome.
Not many studies on Doxycycline and its effect on microbiome

What about antimicrobial resistance?? We know gonorrhea has developed resistance to everything we have thrown at it, with azithromycin serving as a cautionary tale

Doxycycline is important for chalmydia, syphilis, and Mycoplasma genitalium, with resistance needing to be followed closely.
Not much data on chlamydia and syphilis resistance, theoretical potential of syphilis resistance to doxy but still primary non-betalactam

As for Mycoplasma genitalium, 11% in Ipergay had Mgen, we know there are high rates of resistance to macrocodes and increasing to quinolone, with doxycycline being the alternative, something to definitely keep in the back of our minds and again need more data for all of these

And lest we not forget, doxycycline is effective against Staph aureus, and increased use can increase resistance to Staph aureus (subclinical resistance present)

Now for implementation:
We still don't know the best way to implement currently with pros and cons for broader and more restrictive use
Counseling points included below but also need to discuss risk of AMR and side effects

Other implementation considerations:
Doxycycline is affordable out of pocket!
Lab monitoring is more difficult (as always) - consider CBC, renal, and liver function test monitoring periodically (every 6 months? annually?)
STI screening every 3-6 months?

DoxyPEP should most definitely be integrated in HIV PrEP and HIV ART services!!

So overall DoxyPEP is a game changer! It allows us to meet our patients where they are at! It has great effect! It is affordable! It is user friendly! But also we need to monitor antimicrobial resistance for sure and see who this may most benefit focusing on equity and dec stigma