CDC Publishes Doxy PEP Clinical Guidelines for Bacterial STI Prevention

Cross-posted from: NCHHSTP Director Letters

CDC published clinical guidelines on counseling patients regarding doxycycline post-exposure prophylaxis (or doxy PEP) for bacterial sexually transmitted infection (STI) prevention. Doxy PEP has proven to reduce the risk of getting a bacterial STI for gay, bisexual, and other men who have sex with men and transgender women at increased risk for these infections (specifically, syphilis, chlamydia, gonorrhea).

CDC recommends healthcare providers discuss doxy PEP with all gay, bisexual, and other men who have sex with men and transgender women with a history of at least one bacterial STI (syphilis, chlamydia, gonorrhea) in the last 12 months. If offering doxy PEP, healthcare providers should write a prescription for self-administration of 200 mg of doxycycline within 72 hours of sex.

These guidelines were finalized after careful consideration of the comments we received earlier from the public and experts, as well as consideration of the available scientific evidence on this topic. We believe this is the right step for right now to protect the nation’s health, although we are constantly learning more about how to prevent STIs. We will continue to adjust our recommendations as additional data are available. We know our work isn’t over with the publication of these recommendations. Important questions remain about the effectiveness of this approach for other populations, as well as potential long-term development of antimicrobial resistance and impacts on the microbiome. Looking ahead, we will leverage existing data systems to monitor the uptake of doxy PEP and how this impacts bacterial STI rates, understand national doxycycline prescribing rates, and identify trends in antimicrobial resistance. As always, we will provide updates as we learn more.  

Doxy PEP represents the first new STI prevention tool in decades, at a time when innovation in the nation’s fight against STIs is desperately needed. We are grateful for your continued collaboration throughout the public comment period and as we work together to help ensure equitable implementation. To that end, we will be providing guidance to the funded STI programs across the nation to help them determine how best to use their CDC resources to support doxy PEP implementation.

Thank you for your continued collaboration and commitment to public health.

/Laura Bachmann/

Laura Bachmann, MD, MPH, FIDSA, FACP
Acting Director, Division of STD Prevention
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
US Centers for Disease Control and Prevention

/Jonathan Mermin/

Jonathan Mermin, MD, MPH
Rear Admiral, USPHS (retired)
Director
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
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