An Antibiotic After Sex Can Help Gay Men Curb STDs But Could Promote Drug Resistance

Research shows that taking doxycycline after sex can help curb STDs; however, there remains an uncertainty that such intervention could boost drug-resistant pathogens.

With the emerging cases of the sexually transmitted disease, a broadening chorus of public health experts is reaching for the Centers for Disease Control and Prevention to support prescribing a preventive antibiotic pill to gay, bisexual men and transgender women who are at high risk of STDs. While a growing body of research indicates that taking doxycycline after sex markedly slower STD infection rates in this population (sparing cisgender women), , some experts have the view that widespread use of the antibiotic for this purpose could render more harm than good by fuelling the global crisis of antibiotic-resistant infections and damaging people's microbiomes.  

The yearly Conference on Retroviruses and Opportunistic Infections held on Sunday in Seattle discussed all the new findings from several doxycycline studies for STD prevention. It included a third randomized trial that revealed that instructing gay and bi men to consume the antibiotic within 72 hours of unprotected sex (a protocol called doxycycline post-exposure prophylaxis, or doxyPEP) can reduce the bacterial STDs risk. This new study, executed in France, randomized about 500 gay and bi men and discovered that doxycycline diminished the rates of gonorrhoea, chlamydia, and syphilis by 51% to 89%.

Another study, executed in Seattle and San Francisco and presented at a July conference, witnessed an overall two-thirds reduction in STDs among gay and bi men and trans women. 

Michael Traeger, a research fellow at Harvard Medical School, offered a modeling study at the Seattle conference in which he and his colleagues examined patient data at the LGBTQ-focused clinic Fenway Health in Boston and recognized what they described as an efficient prescribing strategy to minimize antibiotic use while maximizing impact. He said, '' Administering doxyPEP for 12 months to gay and bi men who had recently had an STD, can potentially prevent up to 42% of subsequent STDs in the overall patient population''.

Countering the drug-resistant perception, another important study in one of the other major doxyPEP trials, revealed that there was no significant increase in doxycycline resistance among three key bacteria, including gonorrhoea and staph. However, it may not resolve the ongoing debate on the matter as Some infectious disease experts are still concerned that doxyPEP adoption could boost drug-resistant pathogens, especially staph. 

Regarding its clinical implications, Dr. Leandro Mena, the CDC's director of STD prevention, stated that ''the agency has already started laying the groundwork for potentially establishing doxyPEP guidelines''. He further declared that the future advancements are expected once the Seattle-San Francisco study is published, presumably by spring. He ensured that CDC is evaluating the intervention's safety, deducing "which populations can benefit the most," and addressing equity concerns.