CDC finalizes endorsement of doxy-PEP for men who have sex with men, trans women

A pharmacist holds a bottle of the antibiotic doxycycline hyclate in Sacramento, Calif., July 8, 2016.
A pharmacist holds a bottle of the antibiotic doxycycline hyclate in Sacramento, Calif., July 8, 2016.
AP Photo/Rich Pedroncelli

The Centers for Disease Control and Prevention (CDC) on June 4 issued final guidelines encouraging providers to discuss doxy-PEP — a relatively new STI prevention medication known as the antibiotic doxycycline — with certain populations of men who have sex with men as well as transgender women.

The CDC’s new guidelines, first issued in a draft proposal eight months ago, note that doxy-PEP should be offered to gay, bisexual, and other men who have sex with men and transgender women who have had at least one bacterial STI — which includes chlamydia, gonorrhea, and syphillis — in the last year. Furthermore, the CDC noted that doxy-PEP “could be discussed, using a shared decision-making approach,” with men who have sex with men and trans women who have not had a bacterial STI in the last year but plan to participate in sexual activities that could lead to the spread of STIs.

Doctors who offer doxy-PEP should prescribe it to be taken within 72 hours after having sex, officials say. Three large randomized controlled trials showed that taking doxycycline within 72 hours reduces the risk of syphilis and chlamydia infection by more than 70% and gonococcal infections by around 50%. The New York City Health Department warned, however, that doxy-PEP does not protect people from mpox, HPV, herpes, HIV, or other viral infections.

The new guidelines coincide with a spike in STIs in recent years, with more than 2.5 million reported cases of chlamydia, gonorrhea, and syphilis in 2022, according to federal officials. In New York City, chlamydia rates among men climbed by 13.2% between 2020 and 2021, while gonorrhea rates saw a 12.9% uptick, the New York City Department of Health and Mental Hygiene reported.

In November of last year, city health officials sent a letter to healthcare providers encouraging them to offer doxy-PEP to prevent bacterial STIs, joining other cities such as San Francisco. That letter also noted that “doxy-PEP could lead to increased antibiotic resistance, with the risk varying by bacteria.”

“In general, infectious disease doctors are cautious about long-term use of antibiotics to prevent infections,” Martin Backer, a clinical assistant professor of medicine and infectious diseases specialist at NYU Langone Hospital–Long Island, told Gay City News earlier this year.

Doxy-PEP is offered at community health clinics such as Callen-Lorde and Housing Works, as well as at the city’s sexual health clinics in Central Harlem, Corona, Morrisania, and Fort Greene.