Doxy-PEP is emerging as an innovative strategy for preventing some Sexually Transmitted Infections (STIs) among gay and bi+ guys in Australia.
Doxy-PEP has been making the rounds in San Francisco since 2022, which has resulted in a drop in STIs in the area. Seeing this impact of doxy-PEP makes us very excited to have it available here!
Supported by the latest evidence and guidance, we’ll dive into how doxy-PEP works, who it’s for and how to maximise its benefits while staying safe. If you’re someone who’s recently had syphilis or has sex without condoms, this could be a game-changer for your sexual health.
In this article:
- Doxy-PEP significantly reduces your risk of syphilis and chlamydia but is not very effective against gonorrhoea.
- Doxy-PEP does not prevent HIV.
- Doxy-PEP can benefit people at higher risk of syphilis, especially anyone who recently had syphilis or multiple other STIs.
- It involves taking 200 mg of doxycycline within 72 hours — that’s up to 3 days — after sex.
- Doxy-PEP should not be taken more than once every three days.
- You’ll still need to go for regular sexual health tests when using doxy-PEP.
What is doxy-PEP?
Doxy-PEP involves taking the antibiotic doxycycline soon after sex to help reduce the risk of some STIs.
Doxy-PEP offers decent protection against syphilis (70–80% reduction) and chlamydia (70–90% reduction) but not gonorrhea (50–55% reduction). Doxy-PEP does not prevent HIV, so make sure you’re still using an HIV prevention method as well.
It’s important to continue getting regular STI tests when using doxy-PEP. This will identify any STIs that sneak through, especially gonorrhea, which doxy-PEP is less effective in preventing. If you’re getting tested for HIV regularly anyway, why not tack on an STI test at the same time?
Is doxy-PEP right for me?
Australian sexual health experts have released a decision making tool for doxy-PEP. This provides preliminary guidance for doctors to understand doxy-PEP and determine if it’s right for you.
Doxy-PEP may be a good option if you are a gay or bi+ cisgender man or trans woman and have:
Doxy-PEP is safe and suitable for people living with HIV (when also meeting one or more of the points above).
Currently, there is not enough research on whether Doxy-PEP is effective for transmasculine people and cisgender women. Therefore, it is not recommended for these folk until we have more evidence.
Remember that STIs, including syphilis, are treatable. If your risk of getting syphilis is low, you might not need doxy-PEP.
Where can I get doxy-PEP?
Australia does not yet have prescribing guidelines for doxy-PEP, so not all doctors will know about it. If you think doxy-PEP could be right for you, discuss it with your doctor and show them this information from Australia’s peak body for sexual health medicine.
Also, not all doctors may be comfortable prescribing doxy-PEP. You may need to go to a different doctor or check with your local sexual health organisation where you might be able to get a doxy-PEP prescription.
How much does doxycycline cost?
Doxycycline isn’t currently subsidised under the Pharmaceutical Benefits Scheme (PBS) for STI prevention. This means that even if you have Medicare, you won’t be able to buy doxycycline at a government-subsidised price. However, a private prescription for doxycycline typically costs less than $20 for 28 tablets. You can also buy a private prescription of doxycycline without a Medicare card.
How do I take doxycycline as PEP?
The correct doxy-PEP dosage involves taking a single dose of 200 mg doxycycline within 72 hours after sex. Doxycycline usually comes in 100 mg pills, so check the label and take two 100 mg pills to make a single 200 mg dose as required.
Keep your dosing simple. If you’ve had multiple encounters over the weekend, taking a single 200 mg dose on Monday morning can cover all sex within the previous 72 hours. Avoid taking more than one full dose (200 mg) every 3 days.
“Doxy-PEP is as easy as 1, 2, 3. That’s 1 dose of 2 pills up to 3 days after sex.”
Example dosing guide
Doxycycline side effects
Doxycycline is generally safe and well-tolerated. It’s widely used to treat certain infections, control acne, and prevent malaria. If you’re considering using it for doxy-PEP, here’s what you should know:
- Nausea is the most likely side effect. Doxycycline is best taken with a little food and a big glass of water to avoid reflux and an upset stomach.
- Photosensitivity: Doxycycline can make your skin more sensitive to sunlight, causing a rash or sunburn. Limit sun exposure and use suitable sunscreen.
- Rare serious reactions: Oesophageal ulcers are rare and typically resolve after stopping use. Talk to your doctor if you experience prolonged discomfort.
- Gut microbiome: Like other antibiotics, doxycycline may affect the ‘good bacteria’ in your stomach. However, there is limited evidence to suggest doxy-PEP would affect your gut significantly.
- Antimicrobial resistance: Like all antibiotics, frequent doxycycline use can contribute to resistance, making some infections harder to treat. This is also why regular STI testing is essential. Reassess your need for doxy-PEP with your prescribing doctor every 3–6 months.
Although it’s not for everyone, doxy-PEP offers a new and exciting way to prevent certain STIs among some gay and bi+ guys in Australia.
Using doxy-PEP is just one way of helping prevent STIs. Using condoms, lube and going for regular sexual health tests are other ways you can help prevent, test for and treat STIs. Doxy-PEP does not prevent HIV, so make sure you still use an HIV prevention method. The good news is that they’re all compatible with doxy-PEP!
For more information on sexual health topics for gay and bi+ guys (cis and trans), refer to our Knowledge Hub.