Doxy-PEP means taking the antibiotic doxycycline after sex to reduce the risk of getting STIs. Doxycycline 200 mg is taken orally within 72 hours (and ideally within 24 hours) after condomless sex for cisgender men who have sex with men (MSM) and transgender women to reduce the risk of getting chlamydia, syphilis and gonorrhea.
Alameda County, Contra Costa County and California state public health departments are asking providers to consider offering doxy-PEP to cisgender men who have sex with men and transgender women who are interested in doxy-PEP and have had an STI in the past year, are living with HIV or are on PrEP. Doxy-PEP is currently an off-label use of doxycycline. Doxy-PEP’s risks and benefits should be discussed with a provider and as as part of comprehensive sexual health care, including HIV PrEP and PEP for those who are HIV-negative and with STD+HIV screening every 3 months. Click for STD+HIV testing info in the East Bay.
Evidence for doxy-PEP efficacy:
Studies have found that doxy-PEP has reduced bacterial STI rates by over 60%. Data presented at CROI 2023 confirmed doxy-PEP’s efficacy among MSM and transgender women. A study in Kenya published in December 2023 did not find efficacy for doxy-PEP among cisgender women at high risk for STIs. However, the analysis found very low levels of adherence (29%), suggesting that low adherence led to the trial not showing efficacy. A doxycycline drug level study found that doxycycline drug levels were at similar inhibitory concentrations for people assigned male vs. female at birth, in rectal and vaginal tissue. This data may lead clinicians to offer to MSM and transgender women at ongoing risk for STIs and also consider offering doxy-PEP for people assigned female at birth with shared decision-making around the risks and benefits.
This page will be updated with new doxy-PEP resources and guidance relevant to the East Bay community as they become available:
- California State doxy-PEP guidance (4/28/23)
- Alameda County doxy-PEP health alert (2/7/23)
- Contra Costa County health alert on Doxycycline Post-Exposure Prophylaxis (Doxy-PEP) (3/21/23)
- SF doxyPEP recommendations (10/20/22)
- Santa Clara County Public Health guidance letter and corresponding provider fact sheet. (3/20/23)
- Lifelong Doxy-PEP Epic Smartphrase
- SF City Clinic has a doxy-PEP one-page flyer for community members in English and Spanish and an infographic. Please keep it mind that these materials have not been updated with the data around doxy-PEP for cisgender women, so please know that we don’t have evidence yet that it works for vaginal/front-hole exposures. (10/2022)
- CDC doxyPEP considerations
- NACCHO webinar on doxy-PEP (National Association of County and City Health Officials) with Dr. Julie Dombrowski, one of the doxy-PEP study researchers, focused on the study data and public health implications and implementation of doxy-PEP. (11/15/2022)