DoxyPEP

Overview

Doxycycline post-exposure prophylaxis (DoxyPEP) is a way of taking an antibiotic medication called Doxycycline after sex to reduce the risk of acquiring syphilis (and chlamydia). It will not reduce the risk of other STIs, such as gonorrhea and HIV.

It can prevent around three quarters of syphilis infections.

Who should take DoxyPEP?

DoxyPEP is likely to benefit people who are at higher risk of syphilis infection, such as:

• Some gay, bisexual and other men who have sex with men
• Some transgender women

Within the above groups, there are situations where DoxyPEP may be particularly advisable, such as in

• People who use chemsex drugs or attend group sex parties
• People with recent, multiple, new partners
• Anyone diagnosed with a bacterial STI (syphilis, chlamydia or gonorrhoea) in the last one year

There may be other people who would benefit from taking DoxyPEP. If you feel you would benefit from taking DoxyPEP, speak with one of our doctors or nurses at an Umbrella clinic.

Who should not take DoxyPEP?

DoxyPEP should not be used by people who have an allergy to Doxycycline, or any other antibiotics that are part of the Tetracycline family.

Doxycycline can interact with other medications and may not always be suitable to use in combination.

Excess alcohol and over-the-counter medications, such as antacids and stomach ulcer medications, can reduce the effectiveness of DoxyPEP.

Please let your doctor/nurse know of any prescribed, herbal or over-the-counter medications you are taking.

Pregnancy and DoxyPEP

Speak with a clinician before taking DoxyPEP if you are pregnant, think you may be pregnant or are breastfeeding.

How to take DoxyPEP

• Take 200mg of doxycycline (2 x 100mg tablets) with a glass of water
• Stay upright for at least 30 minutes after taking the doxycycline
• Avoid sunbeds and wear sunscreen with high SPF as doxycycline can make you more sensitive to sunlight
• Avoid antacids or supplements containing aluminum, calcium, magnesium, zinc, iron, or bismuth for 2 hours before or after taking doxycycline

When to take DoxyPEP

If a condom is not used, take DoxyPEP within 24hours (or no later than 72hours) after oral, anal, or vaginal/frontal sex.

If you have sex again within 24hours of taking DoxyPEP, take another dose 24hours later. No more than 200mg Doxycycline should be taken within a 24-hour period.

For those who have frequent sexual intercourse, DoxyPEP can be taken three times per week on spaced days (e.g., Monday, Wednesday, Friday) to provide continuous cover.

Side effects

Doxycycline is generally well tolerated, but common mild side effects include:

• Gastrointestinal symptoms such as nausea, vomiting and indigestion
• Sensitivity of the skin to sunlight
• Headaches

Antimicrobial resistance

Antimicrobial resistance occurs when bacteria that cause infections evolve or change so that they are no longer affected by antibiotics that normally kill them.

The risk of antimicrobial resistance increases when antibiotics are overused when they are not needed.

There is a worry that using doxycycline regularly may lead to antimicrobial resistance or upset the balance of healthy bacteria in the body. However doxycycline has been used for long-term treatments of other conditions, such as acne, without causing antimicrobial resistance. Ongoing research will help us understand the potential impacts of DoxyPEP on antimicrobial resistance.

STI screening on DoxyPEP

DoxyPEP is not 100% effective at preventing syphilis and does not protect against other STIs, so it is important to keep up to date with STI screening.

Is it recommended to get tested every 12 weeks (3 months) for those who have multiple sexual partners, sex without condoms or when you change partners.

If you are experiencing any STI symptoms, contact the clinic for a review.