Doxy-PEP - What Health Care Providers Need to Know

Doxycycline Post-Exposure Prophylaxis (Doxy-PEP). For the prevention of bacterial sexually transmitted diseases. Works be when taken within 24 to 72 hours after condomless sex.

General Information on Doxy-PEP

What is Doxycycline Post-Exposure Prophylaxis (Doxy-PEP)?

Doxycycline post-exposure prophylaxis (Doxy-PEP) is a self-administered antibiotic treatment taken after sexual activity. It is used to prevent syphilis, chlamydia and gonorrhea, which are bacterial sexually transmitted infections (STIs). Doxy-PEP is a proven biomedical intervention.

How effective is Doxycycline Post-Exposure Prophylaxis (Doxy-PEP)?

Studies show that Doxy-PEP can significantly reduce the risk of contracting chlamydia and syphilis, and to a lesser extent gonorrhea, particularly for transgender women and cisgender men who have sex with men. These findings highlight the effectiveness of Doxy-PEP as a preventive measure for these bacterial STIs.

Prescribing Information on Doxy-PEP

Why prescribe Doxycycline Post-Exposure Prophylaxis (Doxy-PEP)?

New York State continues to see higher rates of STIs in young people, non-Hispanic Black individuals, and men who have sex with men, and with the increasing rates of congenital syphilis, preventing STI acquisition among persons of reproductive capacity is a priority.

How should Doxycycline Post-Exposure Prophylaxis (Doxy-PEP) be prescribed in a clinical setting?

  • Talk to your patients about their sexual history, risk of STI acquisition and the potential benefits/risks of Doxy-PEP, as well as other prevention options.
  • Provide Doxy-PEP following a thorough sexual health risk assessment and a collaborative decision-making process with the patient. This discussion should cover the effectiveness and potential benefits of Doxy-PEP, as well as other STI prevention options, such as condom use, partner notification and Expedited Partner Treatment or EPT.
  • For questions regarding prescribing Expedited Partner Treatment or EPT for patient's partners taking Doxy-PEP, please refer to Questions, Answers, and Best Practices for Expedited Partner Treatment (EPT) - Clinical Guidelines Program.

Offer Doxy-PEP to:

  • Consider prescribing Doxy-PEP on an episodic basis for patients who anticipate times when their STI risk may be higher (e.g., group-sex events or engaging in multiple encounters with partners of unknown STI status).
  • Cisgender men and transgender women who have had condomless sex with more than one cisgender male or transgender female partner in the past year.
  • Patients currently on HIV Pre-exposure Prophylaxis (HIV PrEP), or who could benefit from HIV PrEP, as similar condomless sexual behaviors may put them at risk for other STIs, aside from HIV.
  • Although current literature is limited on the effectiveness of Doxy-PEP among cisgender women, transgender men and gender-diverse patients assigned female sex at birth, Doxy-PEP may be considered as a sexual health option through shared decision making between the patient and provider on a case-by-case basis.

What should providers know about prescribing Doxycycline Post Exposure Prophylaxis (Doxy-PEP)?

  • Ensure that patients fully understand the benefits, risks, and potential side effects of Doxy-PEP.
  • Keep thorough records of patient discussions, consent, and treatment plans and address the possible risk of antimicrobial resistance for long-term use.
  • Monitor patients regularly for side effects and ensure appropriate follow-up care.
    • Doxycycline can cause gastrointestinal adverse effects, photosensitivity, and esophageal irritation. Recommend taking with a sufficient amount of water.
    • Screen for syphilis, gonorrhea, chlamydia, and HIV every three months at all anatomic sites of exposure.

What about patient counseling on Doxycycline Post-Exposure Prophylaxis (Doxy-PEP)?

Follow-up and patient counseling are advised on:

  • Risks and potential side effects of Doxy-PEP.
  • Recommend that patients remain upright for 30 minutes after taking doxycycline to reduce pill esophagitis.
  • Sexual health routine options to prevent STIs, including HIV, to those at risk of acquisition, including Doxy-PEP, EPT, HIV PrEP, HIV PEP, and vaccinations for Hepatitis A and B, Mpox, and Meningitis.
  • How to prevent HIV because Doxy-PEP does not help prevent HIV. Talk to your patients about the medicines for HIV PrEP and HIV PEP to prevent HIV.
  • Pregnancy considerations: remind patients that Doxycycline should be avoided during pregnancy. Counsel patients who could get pregnant to stop doxycycline immediately if they become pregnant.

Patient Information on Doxy-PEP

How should patients take Doxycycline Post-Exposure Prophylaxis (Doxy-PEP)?

Ideally, Doxy-PEP should be taken within 24 hours, but no later than 72 hours after condomless sex (oral, anal, vaginal).

  • Doxycycline can be taken every day depending on the frequency of sexual activity. However, no more than 200 mg of doxycycline should be taken in a 24-hour period.
  • Milk and vitamins containing positive cations (e.g., calcium, zinc, magnesium) should be avoided within 2 hours of taking doxycycline, because these interfere with doxycycline absorption and may lower doxycycline levels, potentially reducing efficacy.
  • Recommend that patients remain upright for 30 minutes after taking doxycycline to reduce pill esophagitis.

Where can patients find more information on Doxycycline Post-Exposure Prophylaxis (Doxy-PEP) or how to locate a Health Care Provider?

Additional Health Care Provider Resources on Doxy-PEP

Where can health care providers access detailed Doxycycline Post-Exposure Prophylaxis (Doxy-PEP) guidance and resources?