Key takeaways
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The U.S. Centers for Disease Control and Prevention is prepared to recommend the use of a strong antibiotic to prevent sexually transmitted infections. The CDC issued draft recommendations , recommending that doctors consider prescribing doxycycline to help prevent the spread of disease. Officials told CBS News that the approach could mark a turning point in the country’s ongoing epidemic of sexually transmitted infections, or STDs.
Background
The incidence of sexually transmitted infections (STIs) caused by Neisseria gonorrhoeae (causing agent of gonorrhea), Chlamydia trachomatis (causing agent of chlamydia), and Treponema pallidum (causing agent of syphilis) continues to increase in the United States. Novel approaches are needed to address the STI epidemic, especially for disproportionately affected populations . Post-exposure prophylaxis ( PEP) involves taking medication to prevent infection after possible exposure and is a common strategy for preventing HIV and other infections.
PEP is a form of chemoprophylaxis and differs from pre-exposure prophylaxis (PrEP), which involves taking a medication before exposure occurs. Doxycycline , a broad-spectrum tetracycline antibiotic, is used as pre- or post-exposure prophylaxis to prevent infections such as malaria and Lyme disease. Doxycycline is well absorbed and tolerated, with a half-life of approximately 12 hours.
The adverse effects most associated with doxycycline are photosensitivity and gastrointestinal symptoms, including esophageal erosion and ulceration. Most adverse effects resolve when the medication is stopped. Doxycycline is the recommended treatment regimen for chlamydia and an alternative treatment for syphilis in non-pregnant patients with severe allergy to penicillin or when penicillin is not available.
Summary (CDC)
The Centers for Disease Control and Prevention (CDC) of the Department of Health and Human Services (HHS) announces the opening of a docket for comments on proposed guidelines for the use of post-exposure prophylaxis ( PEP) with doxycycline for the prevention of sexually transmitted bacterial infections (STI). Proposed guidelines for the prevention of bacterial STIs include doxycycline post-exposure prophylaxis (doxycycline PEP) because it has demonstrated benefits in reducing chlamydia, gonorrhea, and syphilis infections and represents a new approach to addressing the prevention of bacterial STIs. STIs in populations at higher risk of contracting these infections.
PEP with doxycycline, when offered, should be implemented in the context of a comprehensive sexual health approach that includes risk reduction counseling, STI screening and treatment, recommended vaccination, and linkage to HIV pre-exposure prophylaxis ( PrEP), HIV care, or other services, as appropriate. The purpose of the proposed guidelines is to provide updated clinical guidance for healthcare providers to inform the use of PEP with doxycycline to prevent bacterial STI infections. CDC has made a prerecorded briefing presentation available to provide information on the studies considered in developing the proposed guidance, explain the public comment process, and provide an overview of the agency’s important monitoring of antibiotic use and antibiotic resistance. will consider addressing potential risks.
Comments
Dubbed Doxy-PEP (short for doxycycline post-exposure ), the approach calls for taking the antibiotic after a possible exposure to an STI, rather than waiting until the disease is diagnosed.
"Groundbreaking innovations will be needed to reverse the STI epidemic. And Doxy-PEP is the first major new prevention intervention we have for STIs in decades," said Dr. Jonathan Mermin, director of the CDC’s National Center for HIV. , Prevention of viral hepatitis, STDs and tuberculosis.
If the draft recommendation is adopted, Doxy-PEP would be recommended for gay and bisexual men; other men who have sex with men; and transgender women who have been diagnosed with at least one STI caused by bacteria in the last year. Those infections include gonorrhea, chlamydia or syphilis.
The CDC is expected to advise doctors that prescribing a 200 mg dose of doxycycline "should be considered" for these patients within 72 hours of oral, vaginal, or anal sex.
The agency needs more data before recommending it to other groups.
The CDC is not the first to endorse this strategy. The health departments of California, Michigan and New Mexico, among other agencies, already have guidance on Doxy-PEP.
David Harvey, executive director of the National Coalition of STD Directors, praised the proposed recommendation. "There’s not a lot of money for STI care, prevention and research," Harvey told CBS News. "So this development is profound for our field. And the community has already been working hard to implement Doxy-PEP and doctors at some public health clinics are prescribing it widely."
The CDC’s recommendations could help cover the cost of the pills through public health budgets and insurance, he said.
As part of the CDC’s draft recommendation, doctors are asked to evaluate the side effects of Doxy-PEP and perform screening tests every three to six months to look for breakthrough infections.
"Larger evaluations can sometimes show negative results that have not been detected in smaller randomized trials," Mermin said. "Therefore, we will continue to monitor and evaluate the implementation of Doxy-PEP over time."
It is worrying whether this idea will lead to antibiotic resistance . Experts who spoke at a meeting of the National Association of County and City Health Officials last year warned about that issue. The CDC plans to monitor drug resistance and update guidelines as necessary, Mermin said. "Important questions remain about potential risks," he added.
The CDC will receive comments for 45 days on the recommendations, until November 16. A final version is likely to be released early next year. "We believe this is the right step at this time, although the science is still evolving," Mermin said.
