Sexually transmitted infections (STI) disproportionately impact the LGBTQ+ community–and a new “morning after” treatment hopes to be another tool in the ongoing fight for sexual health and wellness.
Doxy PEP is a medication used to treat bacterial STIs after exposure. Doxy PEP uses doxycycline, a common antibiotic used for treating acne, respiratory infections and often prescribed to treat diagnosed cases of syphilis and chlamydia.
Although the CDC recently published clinical guidelines encouraging healthcare providers to prescribe doxy PEP, there is some concern about the medication increasing antibiotic resistance. Neighborhood Family Practice HIV Prevention Nurse Brittani Flory said the medical community believes the STI epidemic is so severe that it’s worth the risk.
The Buckeye Flame spoke with Flory about this recently approved treatment, where it’s going, and whether there are any drawbacks. To listen, click play directly below or read our (edited) conversation beneath the audio link.
Thank you so much, Brittani, for coming on to just talk about doxy PEP because it seems to be really exciting. It’s in the news a lot, but, what does it do? Can you give me a basic rundown? I know it was originally skin medication, right?
FLORY: We actually use doxycycline to treat a lot of different things, acne being one of them.
We have come in the last couple of years, through studies and through safety monitoring, to realize that Doxycycline can be used almost like the “morning after” pill, but for STIs.
Especially given our current pandemic of STIs–specifically chlamydia and syphilis–doxy PEP is a really great tool for a lot of people to decrease their chances of contracting an STI in the first place.
The data really supports decreasing the rates of chlamydia and syphilis, and there’s some limited data on gonorrhea just because through the last few decades we have lost a lot of classes of antibiotics that treat gonorrhea.
There’s been a lot of resistance in gonorrhea, so it sort of protects against gonorrhea, but that’s not the main focus of things. I think it’s about 50% for gonorrhea. It reduces (risk) much higher for chlamydia and syphilis.
You mentioned the STI epidemic as being an important reason for why this medication is really important for people to take, but what are some drawbacks? Does it have any?
We know that antibiotics, whatever you’re taking it for, comes with some side effects.
Specifically this time of year, doxycycline can make anyone more sensitive to the sun, so we have to make sure that we’re really being mindful of using extra sunscreen, sun shade, hats, those types of things. You should stay sitting upright, if you can, for about 30 minutes after taking a dose. And then, of course, this one can sometimes be for some people a little bit harder on the belly. So we have to make sure that we’re taking it with food. It’s okay to take without food, but taking it with food does help decrease the risk of having an upset belly and diarrhea.
We want to make sure we’re drinking extra water with this medication too. Doesn’t have to be an extra like 64 ounces a day on top of what you’re already drinking, but just a few extra glasses and making sure we’re taking it with a full eight ounces of water.
What about insurance? Is doxy PEP covered by insurance?
Typically, yes. Doxycycline is a very cheap medication. So even if someone doesn’t have insurance, we can do like a good perscription at the pharmacy, or if they want to pay cash price, doxycycline is very inexpensive for folks to get.
I can’t speak for other healthcare organizations, but a lot of our providers are prescribing doxy PEP with patients in those conversations in the rooms or on the phone. It’s two pills taken, ideally within 24 hours after a potential exposure, up to 72 hours.
That’s (around) 200 milligrams. We usually are sending folks home with enough for 30 encounters. That could be 30 encounters with the same partner, regardless of what that looks like. For some patients that might last them a while, other patients that might not.
And doxy PEP is a really, really good conversation for a lot of people to also talk about PrEP, the pre-exposure prophylaxis, to prevent HIV.
So we have a lot of folks who are on both, Oral PrEP or injectable PrEP are totally fine to take with doxy PEP.
Is there a certain population that is being targeted towards doxy PEP?
Unfortunately, STIs, including HIV, disproportionately affect our LGBTQ+ populations. We’re really gearing doxy PEP towards people who have receptive anal sex, men who have sex with men or bisexual men who have sex with men. We’re also looking for folks who maybe have had an STI in about the last six months or so, just because if they have had (an STI) or even been exposed to something in the last six months, there’s a greater likelihood that they may come in contact with something again.
Folks who have vagina have to be a little bit more cautious with doxy PEP because Doxycycline is not safe in pregnancy for folks who can have a pregnancy. It’s not that folks who have vaginas can’t be on doxy PEP. It’s just we don’t have quite enough data yet.
That is an individualized conversation as it all should be.
What are some misconceptions with doxy PEP?
There’s still a lot of shame and misconceptions about prevention medication.
People are making educated decisions to help protect themselves and also protect other people. Because if someone takes doxy PEP and they don’t get an STI, that’s also protecting their current or next partner, right?
We also just encourage people to ask questions, call if something comes up, send a MyChart message in, those types of things. We’re here to answer absolutely what we can. And if I don’t know something, I work with fabulous team members who we can get you answers.
Sex is a normal, healthy part of life, so let’s give people the tools to make it the best and safest experience that they can.
You touched on this a little bit in regards to gonorrhea, but are there concerns of doxy PEP increasing bacterial STI resistance?
Like we kind of mentioned earlier, we have use our tools to get ahead. We don’t want to overuse doxy PEP.
We want to make sure people are good candidates for medications that they’re taking. And that’s really important. That’s across the board for everything from blood pressure to diabetes to doxy PEP. We want to make sure we’re giving people the tools that fit their life in those moments that they need.
We’ve been using doxycycline for a long time for acne and people tolerate it just fine for those types of things. We absolutely have the ongoing studies looking at whether this increases resistance.
Is there anything else I didn’t ask that you want to let me know about?
I really want people to be encouraged to bring doxy PEP up with their health care providers, whether that’s their primary care provider, whether they’re at a sexual health clinic, or wherever they are.
Ask questions, and also, if you’re comfortable, talk about it with your friends, too. The more that we have good conversations about doxy PEP, the more people can utilize it if it fits the needs in their life.
It’s a safe medication and we really want to get it in the hands of people and also just to encourage regular testing. Come ask questions. Let’s get tested. It’s a normal part of life. 🔥
- Read all about the NFP’s HIV & Prevention Care/Services by visiting their site here. On the site, you can schedule an appointment for a health screening and learn more about services including testing and PrEP.
- Go to OHIV’s website for access to resources, such as free PrEP and at-home HIV tests.
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