#28: DoxyPEP: the morning-after STI pill
HEALTHCARE EXPERTS: Paolo Dib, MD; Hyman Scott, MD | COMMUNITY REVIEWER: Bailey Edwards
RESOURCES
CDC Guidelines here (if the link doesn’t exist, call your congressional representatives!)
Info from a public health clinic here (English and Español)
And more info from an LGBTQ health clinic here!
Find doxyPEP near you!
SHOW NOTES
DoxyPEP vocab break down
Doxy = doxycycline, a pill version of a common antibiotic
PEP = post exposure prophylaxis. “Prophylaxis” means something used to prevent something. “Post exposure” means after there was an exposure, in this case sexual activity.
Post exposure prophylaxis is a generic term. Here it's talking about using doxycycline after a sexual encounter with a potential exposure to a sexually transmitted infection
Not to be confused with PEP for HIV (which is taken after you have sex) or PrEP for HIV (which is taken on a regular basis or as needed before you have sex)
DoxyPEP works!
DoxyPEP, when taken within 72 hours after sexual activity, lowers the risk of getting chlamydia, syphilis, and gonorrhea all together by 2/3rds!
Phrased another way, DoxyPEP taken after sex lowers the risk of getting a bacterial STI by 65%!
DoxyPEP works slightly better for chlamydia and syphilis versus gonorrhea. But it does provide protection for all three.
DoxyPEP as of spring 2025 is only recommended in the guidelines for people assigned male at birth. There is new emerging data and assigned female at birth populations, but for now there are no guidelines that recommend the routine use outside of assigned male at birth folks.
How to take doxyPEP
DoxyPEP is 200mg of doxycycline hyclate or doxycycline monohydrate; each version works just as well and it is often up to your insurance company which is paid for.
The maximum dose for DoxyPEP is 200mg in a day or 24 hour period.
DoxyPEP can be taken up to 3 days or 72 hours after a sexual encounter. Both of our expert voices recommend taking it as soon as possible after a sexual encounter to minimize forgetting to take it.
The 200mg dose is two pills taken at the same time. our experts were clear to make sure that folks should take it with a glass of water so it does not cause something called pill esophagitis, or when a pill irritates someone's food pipe.
DoxyPEP should not be taken with milk, vitamins, and certain metal supplements like zinc or magnesium. It's not harmful to do so, but it decreases how well doxycycline gets absorbed into the body and therefore how well doxycycline will prevent STIs.
Doxycycline can interact with other medications. It's always important to discuss taking doxycycline with your provider.
What about antibiotic resistance!?
Antibiotic resistance is a global health concern. For STIs there is a concern that current treatments that cure STIs like gonorrhea and chlamydia, would no longer work if antibiotic resistance became more of an issue.
Here’s what Dr. Scott said about abx resistance: “the extent that it happens, and the extent that it matters that it happens is unclear.” In short we're not sure to what degree antibiotic resistance will be an issue in folks use DoxyPEP.
But! There is new data to show that folks using DoxyPEP have overall less antibiotic exposure on average because they prevent more STIs whose treatment would have required more antibiotic exposure.
If you use DoxyPEP but still get an STI, the antibiotic treatment to cure chlamydia, gonorrhea, or syphilis is still the same.
Looking forward!
Dr. Scott pointed out the potential for stigma around sex that could limit DoxyPEP use in populations that would benefit the most from STI prevention.
Ultimately, DoxyPEP should be a patient-focused decision around minimizing someone's risk of getting an STI.
DoxyPEP is an exciting new technology for STI prevention! New clinical data continues to be published and guidelines will be updated with time. see the links below for resources on up-to-date information about DoxyPEP.
TRANSCRIPT
Dr. Scott: We have this opportunity with DoxyPEP since it's new, it's actually quite cheap, it's easily available, it's commonly prescribed. This isn't an antiretroviral that is only prescribed by subset of providers; people are on it for very common indications. I tell everyone that this is something that you should consider if you're interested in it. It's something that we can offer you.
[QHP THEME MUSIC STARTS]
Gaby: Welcome to Queer Health Pod!
Sam: I'm Sam. I use he/him pronouns, and I am a primary care doctor in New York, and my first sexually transmitted infection was…just kidding! That is not our fun fact.
Gaby: I am Gaby. I use she/her pronouns. Also a primary care doctor in New York. And my first dental cavity was at the age of, no, that's still not fun…uh - uh.
Sam: Nuh-uh.
Richard: And I am Richard, and I use he and him pronouns. And I am also a primary care doctor in New York City, and I've been practicing LGBTQ+ Health for 20 years, and today we're actually talking about preventing sexual cavity infections. How's that for a fun fact?
Gaby: Jury's still out, but: you are listening to Queer Health Podcast, season three: DoxyPEP.
[QHP THEME MUSIC ENDS]
Sam: DoxyPEP. [lip flubber noise] That is doxycycline post-exposure prophylaxis, or the antibiotic doxycycline taken after a sexual encounter to prevent chlamydia, syphilis, and gonorrhea.
Gaby: So post-exposure prophylaxis is basically medicalese for something that's used after an exposure to prevent you from getting sick. So this is like morning after pills for birth control. You know, something you only use afterwards. You may have heard of PEP in the context of HIV. There we're talking about medications to prevent HIV after an exposure.
Richard: And for even more clarity, we're not talking about HIV today. When we talk about STIs today, we're talking about three big bacterial, sexually transmitted infections, chlamydia, gonorrhea, and syphilis.
Sam: Those three – again, chlamydia, gonorrhea, and syphilis– are the most common bacterial, sexually transmitted infections. In 2023 there were over 1.5 million cases of chlamydia in the US and about 600,000 cases of gonorrhea. Syphilis, even though it's less frequent, has gone up about 60% from 2019 to that most recent year of 2023's data.
Gaby: And these big numbers are actually why DoxyPEP º again, just for clarity, that is doxycycline post-exposure prophylaxis – is this exciting new technology. It's an easy to take medication (that’s the doxycycline itself) and it's known to reduce the risk of these three big STIs.
Sam: This episode will dive into the reason people might take DoxyPEP, when and how to take DoxyPEP and speak to some concerns about antibiotic resistance. (Horror noise)
Richard: Both the use of sound effects and your concern about antibiotic resistance may be a touch overkill.
Sam: True – and more on antibiotic resistance later. This episode’s a slightly different format. We've skipped the community voice and are gonna get right to the clinical experts.
Gaby: And with that, let's introduce these two clinical experts for today's episode. At the top of the episode, we heard from Dr. Scott who is among many other things that he'll tell you about an infectious disease doctor.
Dr. Scott: My name is Hyman Scott. I'm a physician researcher here in San Francisco. I have been one of the investigators in the doxyPEP study and also a PrEP provider and doxyPEP provider at a community clinic called Strut that's part of the San Francisco AIDS Foundation.
Sam: Our second clinical expert is one, Dr. Paolo Dib.
Dr. Dib: My name is Paolo Dib pronouns are he, him. I'm a primary care doctor and an HIV specialist. I work at both Bellevue's Pride Health Center as well as Callen Lorde Sexual Health Clinic.
Sam: Now that everyone's seated at the DoxyPEP dinner table, let's hear just how well DoxyPEP does at preventing STIs.
Dr. Scott: When I'm counseling patients on DoxyPEP, I started with the high level description that this works for preventing STIs and, you know, I say it's, 65-70% reduction in STIs. It’s, uh, higher for syphilis and chlamydia and lower for gonorrhea. I do make it clear that it's not 100%.
Sam: Dr. Scott led with the marquee numbers from the big study that put DoxyPEP on the map. DoxyPEP reduces the risk of getting a bacterial STI when taken within 72 hours by 65%.
Gaby: So Dr. Dib actually reframed that 65 to 70% number in a different way that I think is really helpful.
Dr. Dib: For every three exposures to STIs that you have, you're dodging two of them. You might still get that one, but you're dodging two, which is better than zero. There is still a chance and people should still be tested for that reason and might still need to get treatment. But that overall, over the course of a year or two years, they’ll reduce the number of times they have a true infection. (Applause sound effect)
Sam: Hmm. Is it too late to go back to college?
Gaby: We didn't ask Dr. Scott about a time machine for Sam, but instead we asked about how much we actually care at the public health level about the big three: chlamydia, gonorrhea, and syphilis.
Dr. Scott: We have seen a significant rise in STIs, in particular syphilis, where we're seeing, two and three hundred percent increases in syphilis cases. And when you have, for example, so many more cases of syphilis, you have more cases of really bad complications of syphilis. And we're seeing very large increases in gonorrhea and chlamydia as well.
Sam: Uh, oops.
Dr. Scott: And so we have not really been able to reduce the number of STIs. In the same way we have, for example, HIV pre exposure prophylaxis, or PrEP, which in many communities where we've been able to roll this out aggressively, we've seen dramatic decreases in HIV cases. We have not been able to do that for STIs. And doxyPEP is really, in my opinion, a game changer in the same way that PrEP was for HIV prevention. And so we really need something for preventing this and changing this trajectory of the STI epidemic that's ongoing in the U.S.
Richard: Dr. Scott pointed out the need for new technologies to lower STI rates. So we asked both of our clinical experts about other ways to prevent bacterial sexually transmitted infections.
Gaby: To say it out loud: showering or bathing after sex just doesn't help. Peeing after sex also doesn't lower your STI risk, but it can help people with vaginas, with post-sex urinary tract infections. That's another episode for another time.
Richard: In our douching episode, we talked a little bit about how douching after sex actually increases STI rates slightly. So to be clear, outside of condoms, which we'll come back to in a second, there aren't many things that you can do to lower the risk of getting a bacterial STI.
Sam: We asked Dr. Scott if there are other ways that antibiotics are used to prevent bacterial STIs.
Dr. Scott: We do provide individuals with we call epi treatment. After someone may have been exposed or a partner tells them that they were diagnosed with an STI, we will preemptively treat them for the STI to try to prevent them from acquiring it. Or treating them if they have acquired and are asymptomatic. But that really require someone for what we call epi treatment to come into the clinic, to be able to make an appointment. So you have to connect with the healthcare system and that's a barrier. The things that seem to work for our prevention side of HIV and STIs is really demedicalizing it and allowing people to utilize these tools outside of touch points with the healthcare system as much as possible. And we've seen this with PrEP, where we've seen a lot of uptake in community sites in particular, and we're able to reach our communities that that we haven't been able to reach in other ways to the extent that we need to. We needed new approaches and new strategies to be able to get people access to the prevention options for STIs because we haven't been successful in preventing these really dramatic increases in STIs over the last five to 10 years.
Sam: Dr. Scott mentioned new strategies, which made us ask about some of the issues with old strategies. And when we say old strategies, we're talking about epi treatment and our other favorite old strategy: condoms.
Dr. Scott: Two things. One is condoms never really had, high acceptability. I think it was incredible that the community mobilized around HIV to really increase and normalize condom use within the community. Before the HIV epidemic really had poor, acceptability regardless of, who was using it and what sexual context. The studies that looked at condom effectiveness it has to be 100 percent and it's still around like 70 percent efficacy in preventing HIV and that is 100%. If it's anything less than 100%, they're really, there's really not a lot of efficacy at all for preventing HIV. So we also have to be realistic about what condoms are doing for HIV prevention. And, I think it's sobering to see the surveys that show condom use really declining over time. And we are seeing a decline in HIV cases nationally- it's small, but it is going down- and we've seen more dramatic declines in some cities where PrEP rollout has been much more aggressive.
Sam: Here lies condoms: working only 70% of the time when used 100% of the time. But prior to pre-exposure prophylaxis for HIV condoms were the best technology to prevent HIV and much of the finger wagging "shoulds" of condom teaching really stems from, at least for queer men, the long shadow of the fear of HIV and AIDs.
Richard: It's important to point out how asking folks to put a rubber barrier between them during sex can also be a psychological barrier to intimacy and affirming sex. By bringing in medications like DoxyPEP, we're taking steps towards removing anxiety and returning to the intimacy involved in sex.
Gaby: Which was one of the most powerful things that PrEP for HIV did. And for what it's worth, we do have to connect the dots here: condom use did decline after PreP for HIV became a thing like about a decade ago.
Sam: A decade ago, you mean college? Anyway, what followed with this PrEP for HIV and condom decline question is a big one for the research community. Did PreP for HIV cause a decline in condom use? Or, framed another way: did prep allow people to ditch the condom use that was driven only by the fear of HIV and if so, can we slut shame prep for causing more STIs?
Dr. Scott: So there's a lot of questions about whether or not there's something called risk compensation. If your sexual behaviors are influenced by a concern around HIV and you no longer have that concern, does that lead to more or increased sexual activity? Sexual number of sexual partners? Condom use declining. And I think that there's been some controversy around whether HIV PrEP changes people's sexual behavior. And I think the preponderance of data suggests it probably does. People are more comfortable, they have less stigma, they have less concern, they have less anxiety around sex, which is, are all positive things, in, in my opinion. And many people do use PrEP as a non-condom strategy to prevent HIV. And I think that there's a desire to to tie that increase in STIs to the increased use of HIV prep. The clinical trials though don't really, show a clear correlation. And I don't think that we can make that one to one, like, causal correlation.
Sam: We are making this point about PrEP for HIV because history is repeating itself, or at least we think so. The narratives that popped up when HIV for PrEP was new are now popping up with DoxyPEP for STIs.
Richard: Like any new medical technology, there's a risk and a benefit, but sometimes the benefit when it's something like more empowered and intimate queer sex is not something that everyone values in the same way. And another important point, both of our guests noted that DoxyPEP is indicated and works regardless of someone's HIV status.
Dr. Scott: It is status neutral, so it can be used by anybody, regardless of if they're living with HIV or not living with HIV. And nothing changes if someone's living with HIV has a detectable viral load. It's just something that, works in a completely different pathway for completely different infection. Regardless of someone's living with HIV or not, or undetectable or not. It's something they can use.
Gaby: As listeners of the podcast, know, we are obsessed with data, oftentimes the lack of it in queer health. And so of course we asked Dr. Scott, who has helped lead some of the big DoxyPEP research trials where things actually stand with DoxyPEP and whether it's been sufficiently studied.
Dr. Scott: I think we don't, in my opinion, need another large randomized clinical trial to prove that DoxyPEP works. So there's a consistency across these studies. I think we have enough data to show that this works for STI prevention.
Richard: Whether or not you have a funeral for your condoms, DoxyPEP is well-studied, guideline recommended, and another tool in the STI Prevention playbook. Next, we'll explain the details of how to take, when to take, and who can take DoxyPEP.
[TRANSITION MUSIC]
Gaby: Play it again, Sam
Sam: For what it's worth, I did used to play that song when I did background piano in high school. But –
Gaby: That's maybe the gayest thing you've ever said.
Sam: Oh, gets even gayer when my grandmother referred to those as "the war songs." But I think, let's get back to the point which is that DoxyPEP works when taken within 72 hours after sex, DoxyPEP reduces the bacterial STI by 65%.
Gaby: Or your risk of getting the big three chlamydia, syphilis, or gonorrhea goes down by two thirds when using DoxyPEP.
Sam: Sluts ahoy. So who get on this DoxyPEP boat?
Gaby: So the main clinical trials for DoxyPEP that put it on the map were in gay, bi, and queer cis men and also trans women. There also has been one large and then one smaller study looking at straight cisgender women.
Richard: Let's pause here. Medication protects anatomical tissues involved in specific behaviors, not by anyone's identity. So when labeling the identities studied, we wanna be clear that these are really proxies for the anatomy of the sex being had.
Gaby: Right now, DoxyPEP is recommended by the guidelines for people who are assigned male at birth, and that's because, like I said earlier, that is who was in those main original trials that show that DoxyPEP has a benefit. And we know from these studies that folks assigned male at birth benefit from taking DoxyPEP regardless of the type of sex they have. So that includes penetrative sex, either with a butt or a vagina, shout out to the bi guys, or oral sex of any kind.
Richard: Okay, but what about for AFAB people?
Sam: There was a big study looking at DoxyPEP in cisgender women, but it did not show the same benefit that DoxyPEP had in folks assigned male at birth. We should note that that study had low adherence, meaning many of the participants of the study didn't actually take the medication. Many researchers think that DoxyPEP likely does work for assigned female at birth folks, but we just don't have enough good clinical data to say so with confidence.
Richard: The data for AFAB folks is slowly emerging as of 2025. A small study of cisgender women in sex work showed that DoxyPEP does reduce chlamydia and syphilis rates when taken reliably after exposures.
Gaby: Though the current recommendation is limited to cis men and trans women, again, having any kind of sex, we do anticipate that this recommendation could and likely will broaden once we have some more research under our belts.
Sam: So the deep, dark question we're all asking ourselves that we're bringing to our rabbis, our priests, our lay leaders, our mothers, fathers, grandparents, is: am I slutty enough to take DoxyPEP?
Dr. Dib: Almost anyone who's coming and asking about it in the 1st place, presumably either that more than 1 sex partner or their partner has more than 1 sex partner. In which case, you know, as long as they understand the risk benefit conversation, there's almost never a reason not to at least have it as an option for them.
Gaby: I'm in agreement with Dr. Dib. In practice, there's a ton of flexibility and it's really a conversation with a patient who is in front of you about, "Well, this is where the literature shows there's benefit. But if you wanna take an educated guess and assume it's gonna help you, then I'm happy to prescribe it." Though DoxyPEP is new, the medication underneath it, doxycycline isn't, and we've got a long understanding of how it works in the body and then the side effects to counsel on.
Dr. Dib: So usually the three things I talk about are the fact that it's important to drink it with water and to sit upright for at least 15 minutes. So that it doesn't get stuck in the esophagus, which is really rare. Number two is like, increase the sun sensitivity, so to make sure to wear SPF in the sun. And number three is to not take it with calcium supplements in order to avoid a change in the absorption.
Sam: The whole pill bothering someone's esophagus thing is very rare, but it's very uncomfortable when it happens. So that's why we like to talk about it and give the advice of taking doxycycline with a glass of water.
Gaby: Dr. Scott also pointed out that the tab is less likely than the capsule to cause that kind of throat irritation, so that's something else to consider if people prioritize that concern.
Richard: Another common side effect that's worth mentioning, and I'm looking at you bottoms, is an upset stomach.
Dr. Dib: When there's stomach upset, first step is to try taking it with food as well as water instead of on an empty stomach. Step two is to trial different formulations of doxycycline. And so I make sure to have folks try and see if the problem was actually with the format of the pill rather than the doxy itself.
Sam: Okay, so if you get rocked by taking DoxyPEP from a stomach and nausea and vomiting perspective, let your provider know so they can change the type of doxycycline formulation that you're getting to see if that makes a difference.
Richard: All right. Those are the big anticipated side effects, which leads us next to how someone times their DoxyPEP after sex.
Dr. Scott: It's, it's 2 tablets, ideally as soon after your sexual encounter as possible, but up to 72 hours. So I really encourage them to take it on the way home after their sexual encounter so that it's as close as possible to the encounter.
Sam: Dr. Dib also echoed what Dr. Scott said.
Dr. Dib: I tell people to take DoxyPEP at the time they're most likely to remember to take it consistently. Some people say, oh, I like to take it immediately after. I like when I brush my teeth, take my DoxyPEP. Some other folks, that's not how they remember. It's more like the morning after pill for Like, It's, they wake up in the morning, that's when they think about it. What I say from the medical standpoint is that the first 24 hours are more effective. So if you can do it in the first 24 hours, that is best. However, it's still better to take it within 72 hours than not take it at all.
Gaby: All right, so you've got three days to take it, but the sooner the better as close to sex as possible, basically.
Sam: A common question we get a lot from patients is if they need to use DoxyPEP every single time they have sex or just with folks who they think maybe trust less or had worse lighting in their app photos.
Richard: Oh goodness. We haven't even pointed out how important lighting is for the apps.
Gaby: I just really feel like the token lesbian on this Zoom call, but as to deciding if your partner essentially was sus enough to warrant DoxyPEP use. It's actually kind of a complicated question and we brought it to Dr. Scott.
Dr. Scott: I have this conversation all the time after someone is prescribed doxyPep around this, like, when I check in about how they're using it. I asked, you're using it with all your encounters. Are you making decisions about when to use it? And I'd say the majority of people are surprised to hear that we're recommending that you use it with all your encounters. We've seen that with on demand PrEP as well, where people are making decisions about with whom to use it. You don't know which encounter might lead to an exposure. So you have to cover more encounters to make sure you cover the one that's going to lead to an exposure.
Gaby: Right, so just because someone quote seems like they may have a higher chance of an STI. doesn't mean that your loaded social assumptions are a useful way to decide when to use DoxyPEP.
Richard: Now sometimes folks may just wanna use it in group sex settings or with unknown partners for whom they don't have contact information, which we don't really have pushback on. But maximize how DoxyPEP can work for you. As Dr. Scott said, taking it with every sexual encounter provides maximal protection.
Gaby: Because people do take it at variable rates, providers often give out or dispense different amounts of DoxyPEP at the time of prescription. Dr. Dib encouraged patients to ask for more when they need it, and not assume that whatever is in that initial pill bottle is meant to be any kind of limit.
Dr. Dib: The quantity of pills in the bottle is not representative of how often we expect them to use it or how often they have sex or don't have sex. It's just for them to have, and when they feel like they're starting to run out, they should ask for a refill or just go collect it from the pharmacy. Sometimes people try to spread it out or to use just one pill because they're traveling and need more. Also not recommended.
Sam: There's guidelines now that tell prescribers to start with about 30 doses or 60 pills, but I always tell folks: if you feel like you need more or you want less, next time you pick it up, just let me know and happy to adjust the dose based on how often you use it.
Gaby: All right, so to summarize this section, take 200 milligrams or two pills within one day, but up to three days after having sex.
Richard: And any type of sex.
Sam: Remember that taking DoxyPEP with a glass of water and without multivitamins and supplements helps minimize the side effects and maximize antibiotic absorption.
Richard: If your stomach gets upset, ask your provider about switching types of doxy to see if that helps you.
Gaby: And although taking DoxyPEP lowers your risk of an STI, it doesn't change the recommendation to get routinely tested for STIs, most likely every three months.
[TRANSITION MUSIC]
Sam: And now (scream sound effect) antibiotic resistance.
Gaby: Oh my God (laughter). Antibiotic resistance is, despite the underwhelming editing software effects a very concerning issue. The fear is that the more that we use antibiotics, the more bacteria can adapt to be able to survive certain classes of antibiotics when exposed. In short, things that we can treat now can become untreatable because of resistance.
Sam: When folks talk about super gonorrhea, they aren't talking about Richard in his thirties. Super gonorrhea is one example of antibiotic resistance, and the concern is that that type of gonorrhea would not be treatable with routine medications if it's mutating in response to frequent antibiotic exposures.
Richard: But rest assured, you don't to gay gasp or clutch your pearls at the thought of antibiotic due to DoxyPEP. Dr. Scott explains.
Dr. Scott: Antimicrobial resistance is probably going to happen. And to the extent that it happens, and the extent that it matters that it happens is unclear. What is clear is that this works really well for preventing STIs, and if it only worked for syphilis, I still think it would be a tremendous tool for prevention, and it also works for chlamydia and in the studies gonorrhea. Are there other bacteria that, might develop resistance from the use of doxycycline? Is there bad things that happen to people as a result of that? We haven't seen that in the studies, which are shorter follow up. And not in a community setting, so we might find new things as we're evaluating this. It's a theoretical risk. That's balanced out with an actual benefit. And so I think that cost benefit is something that everyone is going to need to consider. I recommend it and so I tell people, this is something that with all the pluses and minuses, I recommend this as a option for you.
Sam: To repeat what Dr. Scott said about antibiotic resistance, the extent that it happens, the extent that it matters that it happens is unclear. There is new data since we interviewed Dr. Scott, showing that some folks will actually have overall less antibiotic use if use DoxyPEP because it prevented the need for STI treatment.
Richard: There's no need to hear horror violins when talks about DoxyPEP and concerns about antibiotic resistance. I mean, it's not The Last of Us.
Gaby: Ooh. Another show with a lesbian plot. Another question about DoxyPEP and antibiotic use that we asked was, say that you're on DoxyPEP, you took it, you still got diagnosed with an STI. Does the first line recommendation for treatment actually change because you were on DoxyPEP.
Dr. Scott: We wouldn't change treatment, based on that, because we would still treat them for chlamydia with doxycycline, the dose is different. So it's 100 milligrams twice a day instead of 200 milligrams right after sex. And so clinically, what we're seeing is often when people are coming in with STIs it's been a relatively recent encounter because the, window period for developing symptoms is pretty short. And people are often saying that they didn't take DoxyPep for that encounter. There's less of the concern that they had a breakthrough infection.
Sam: We also asked about a situation where someone gets a bacterial STI diagnosis when had used DoxyPEP. Does that mean you automatically have a resistant bacteria because DoxyPEP didn't work?
Gaby: And the answer is no. Doxycycline has a different level of efficacy at different anatomical sites, in part due to how well that tissue can concentrate the active part of the drug.
Dr. Scott: It's not 100%. I think for gonorrhea, particularly at different sites, so people can have gonorrhea in their throat, in their butt, and in their penis, or vagina, and doxycycline levels are different in those different parts of the body. And doxycycline is concentrated in the urine for gonorrhea prevention that you have for urethral infection, for example. The other piece of this is also that, as I talked about epi treatment earlier I've changed the approach towards epi treatment. If someone is on DoxyPEP and is taking it and has covered the sexual activities I don't epi treat them or I offer them epi treatment, but, I don't necessarily recommend that they take it if they've been taking DoxyPEP.
So we test them instead of treating them because when we know we've done the epi treatment, 70 percent of those people don't have an STI and so we've given them antibiotics and, in retrospect unnecessarily. And so there is that saving of antibiotic use as well that doxyPEP allows us to do.
Richard: Alright, so: DoxyPEP has not changed how folks who do use it and get an STI diagnosis get treated for syphilis, gonorrhea, or chlamydia. And again, we know that for these folks, there is a good chance that they would overall see fewer antibiotics because DoxyPEP prevents STIs so well. And in fact, DoxyPEP may lower overall antibiotic exposure by reducing the need for treating without a positive test result.
Sam: We're about to summarize the risk/benefit balance of the potential for antibiotic resistance with DoxyPEP. But before we do that, we wanted to bring back Dr. Scott's point about how the nature of the conversation around antibiotic resistance is too often framed by the stigma of sex.
Dr. Scott: I mean, We need to be clear that this is around sex. And that comes with stigma and, perspectives around, is this okay to use for this indication when, people have other ways theoretically to prevent STIs, including you know, condoms and those kinds of things? I just, I don't really understand. We use prophylactic antibiotics for other indications when we have good data that they work, and we have tremendous data that this works and, these are the types of situations we use antibiotic. I always make the perspective that the amount of antibiotics we use in the livestock industry that this pales in comparison to that. So folks who are really motivated about not driving antibiotic resistance should be working on that and allow us to roll out doxyPEP to prevent these STI s that we've seen 2 and 300 percent increases in. If every LGBTQA+ took DoxyPEP for STI prevention it would still be a a minutia compared to the amount of antibiotics that are used in the livestock industry.
Sam: (mooing) MOOOOVE over resistance.
Richard: No –
Gaby: Absolutely not. No. That was truly no. Nope.
Sam: Did I get your goat on that one?
Gaby: Straight to jail. Straight to jail.
Sam: Sorry, sorry, we'll wrap up. So, we asked our guests for any parting words and they had some, here's Dr. Dib.
Dr. Dib: Don't be shy to ask your physicians, ask your providers, ask your doctors uh, for it, even if they don't know what it is know. Push them to educate themselves about it, because if you have heard enough that you know about it, then you probably deserve to receive it if you want it.
Richard: When my patients come to me after they've started taking DoxyPEP, most have said that it's really a non-issue for them that they don't really experience any major side effects. Some are thrilled because they used to get STIs, like gonorrhea or chlamydia much more often than they're getting them now. They haven't had to receive the ceftriaxone, the injection that we give them really at all since they've been on it, which has been great.
Gaby: And here's Dr. Scott:
Dr. Scott: What I tell everyone is that this is something that you should consider. And you should make a decision about how this would fit in with your your sexual health. And so I would say that it's available for you, regardless of the number or types of sex that you have with people and that we offer this to individuals who have one or two partners and we offer it to people who have way more than one or two partners. I think everyone should know about it and they should make a decision about if it, it works for them. I'm going to reference some of the lessons we learned from PrEP because we did miss a lot on, what risk someone might have be a candidate for PrEP. We made it really hard. In the beginning to get it, it's actually quite hard to still get it for some people. And we created all these criteria because we were worried about, individuals who we might not consider at risk taking this. And now we've jettisoned all of that and just said that PrEP is for everyone. And if someone asks for it, we should give it to them . And I think we should take the same approach with DoxyPEP so that we're not in 10 years back where we are with PrEP. I want to just make sure that people know that this is available for them. And that there are providers who are willing to prescribe this. If you are interested in this, and you need it, we hope that we can have it available for people to meet their sexual health needs.
[QHP THEME MUSIC STARTS]
Gaby: QHP is a power sharing project that puts community stories in conversation with healthcare expertise to expand autonomy for sexual and gender minority folks.
Sam: Thank you to our healthcare experts, Dr. Paolo Dib and Dr. Hyman Scott. We would also like to thank our community reviewer, Bailey Edwards.
Richard: For more information on this episode's topic, check out our website, www.queerhealthpod.com.
Gaby: Help others find this information by leaving a review and subscribing on Spotify or Apple.
Sam: We are on social media. Our handle is @QueerHealthPod.
Richard: Thank you to Lonnie Ginsburg, who composed our awesome theme music, and to the Josiah Macy Jr Foundation who supported some of the tech we use to produce these episodes.
Gaby: Opinions in this podcast are our own and do not represent the opinions of any of our affiliated institutions. And even though we're doctors, don't use this podcast as medical advice. Instead, consult with your own healthcare provider.