Doxy-PEP

What is Doxy-PEP?
Examples
Is Doxy-PEP right for me?
Where do I get Doxy-PEP?
How should I take Doxy-PEP?

What is Doxy-PEP?

PEP stands for “post-exposure prophylaxis,” which means taking preventative medication shortly after risk contact. Some queer people take the antibiotic doxycycline after sex with a high risk of STI transmission to reduce the likelihood of infection.

Studies have shown that this mostly works for syphilis and chlamydia, if taken at the right time. In San Francisco, the overall prevalence of these infections has decreased after about 20% of the community there started using Doxy-PEP.

However, there are also potential downsides. It is currently being debated under which conditions it makes sense to take Doxy-PEP (e.g. which type of risk, how often, etc.) Doxy-PEP does not work against viral STIs like HIV, HPV, or herpes. It also does not work against gonorrhea because most of the infections have already built a resistance to doxycycline.

Studies have shown an effectiveness against syphilis and chlamydia, but only in MSM and trans women who take PrEP or are living with HIV. Studies have not shown an effectiveness for cis women. There has not yet been a study about Doxy-PEP for cis and trans MSM who do not take PrEP and do not live with HIV, or for cis and trans men who do not have sex with men.

Examples

Freddy

Freddy is in a mostly monogamous partnership. However, approximately once per year, he goes to a large gay sex party. He takes PrEP on an as-needed basis and then a dose of Doxy-PEP to minimize the chance that the experience could have unpleasant consequences for him and his partner.
He isn’t worried about taking antibiotics for this purpose, since it happens so infrequently.

Enno

Enno is on PrEP and has already had syphilis multiple times. Enno takes Doxy-PEP a few times per year after group sex or cruising. For Enno, the feeling of safety and security is essential in order to be able to let go in these situations. After all the stress, Enno simply wants to have sex without fear.

Timo

Timo has multiple changing partners. He takes PrEP to protect himself against HIV but is not concerned about bacterial STIs. When he had chlamydia, he didn’t notice any symptoms. It wasn’t so bad. Gonnorhea, however, was painful – but he knows that Doxy-PEP doesn’t protect against it. That’s why it’s enough for him to take a test every three months as a part of his PrEP – and if he ever has symptoms, he goes straight to the doctor anyway. He sees no reason to regularly take preventative antibiotics, especially since they kill good kinds of bacteria as well.

Cherry

Cherry is a trans sex worker, and she takes Doxy-PEP because frequent chlamydia infections limit her earning potential, and she has regular clients who would react negatively to an STI notification. Although it’s not clear how high the risk of transmission is for asymptomatic infections, there is a societal stigma around all things that are sexually transmitted.

Is Doxy-PEP right for me?

According to the experts from the German Society for STIs (DSTIG), Doxy-PEP could be relevant if the following criteria are met:

You are a man who has sex with men, or a trans woman
You take PrEP or you are HIV-positive
You regularly have a high risk of syphilis or chlamydia infections, for example:

You recently had a syphilis infection that reoccurred after treatment
In the last 6 months, you had chlamydia or gonorrhea multiple times and were symptomatic
In the last 6 months, you had sex with at least 10 male partners
You regularly have chemsex or group sex

Other considerations could be:

How often and in what situations would you take Doxy-PEP?
How often are you in particularly high-risk situations?
Do you suffer from a fear of syphilis or chlamydia?
Do you find it very stressful to get tested, and if necessary, get treated and inform your partners?
If you use Doxy-PEP for prevention in the coming year, would you be likely to use more or fewer antibiotics than you took last year as part of syphilis and chlamydia treatments?

After taking Doxy-PEP, side effects such as allergic reactions or photosensitivity of the skin may occur. Nausea, bloating, and diarrhea may also occur. Your gastrointestinal microbiome is also disrupted by Doxy-PEP – the extent and consequences are currently unclear.

Whether Doxy-PEP makes sense for you – i.e. whether the potential benefits outweigh the risks – depends on how you assess all these aspects for yourself.

Where do I get Doxy-PEP?

Doxycycline is prescription-only. Because the medication is not (yet) officially approved for use as a PEP, you usually need a private prescription. The cost of a dose is around 1,20€.

There are online services that offer Doxy-PEP through a subscription by post, without having to visit a doctor. However, they charge much higher costs – for example, 25€/month for 2 pills, which is about 10x as expensive as the pharmacy.

We recommend that you make your decision after a personal consultation together with competent doctors – in an HIV specialist praxis, for example.

How should I take Doxy-PEP?

Discuss the use of Doxy-PEP with your doctor. Take Doxy-PEP after high-risk contact. It doesn’t have to be every time you have sex: the more likely an infection with syphilis or chlamydia could occur, the more sense it makes to take Doxy-PEP afterwards. There must be at least 24 hours between two doses.