Revolutionising Sexual Health: The Journey of doxyPEP and Trying for Change

For decades, women have had the morning-after pill as an option to avoid unintended pregnancies. Now, theoretically available to all, there's a pill designed to thwart bacterial STIs, specifically, gonorrhoea, syphilis, and chlamydia. It's cost-effective and simple to administer, just two pills within 72 hours of intimacy and it proves effective. So, why isn't the NHS making it accessible?

For many across Britain, the memories from the night before might be distressing, or possibly nonexistent due to instances of sexual assault or spiking. However, the broader picture is disconcerting for other reasons.

Sexual health clinics, as highlighted by the Local Government Association, are on the brink of collapse due to escalating demand. Gonorrhoea and syphilis are said to be at record levels that have not been witnessed in over 75 years which is prompting people to call urgent action.

Dr Will Nutland an assistant honorary professor at the London School of Hygiene and Tropical Medicine says that it is a no-brainer to make doxyPEP a frontline medication for the treatment and prevention of STIs. "We were too slow in introducing PrEP (the medication that prevents HIV). We can't make those same mistakes with other technologies,” Dr Nutland told i News.

Yet, the UK lags behind the US and Australia. Concerns about potential antibiotic resistance are raised, and accusations of homophobic attitudes impeding progress echo within the medical field.

What is doxyPEP?

The name 'doxyPEP' comes from the drug and its use. "Doxy" originates from doxycycline, an antibiotic prescribed globally for over 50 years—for dental and gastric infections, STIs, and even acne. It's a generic drug, mass-produced inexpensively after the patent expiry.

PEP stands for "post-exposure prophylaxis," a preventative treatment used after an incident with a potential infection. While post-exposure prophylaxis has been used to help prevent HIV, doxyPEP introduces a similar concept for bacterial STIs. The protocol involves taking 200mg within 72 hours after an unprotected sexual encounter, ideally under a doctor's prescription and supervision.

What evidence suggests doxyPEP works?

In 2022, a US study showcased doxyPEP's effectiveness, reporting an 88 per cent reduction in chlamydia, 87 per cent in syphilis, and 55 per cent in gonorrhoea cases. Overall, a 66 per cent decline in three common bacterial STIs. The study was halted a year early due to the clear results, with no serious side effects reported.

Dr Manik Kohli, an HIV and sexual health doctor, emphasises the need for more studies in women and other individuals, stating, "This is the first intervention that we could implement to really curb the rising rates of STI."

Are women being left behind by doxyPEP?

Trials focused on men who have sex with men and trans women, resulting in limited data for women. A study in Kenya of 449 women reported lower efficacy, partly attributed to imperfect adherence to the medication.

What are the potential risks of doxyPEP?

DoxyPEP doesn't shield against HIV or certain other STIs, meaning that there is still a need for continued testing. Potential side effects include stomach upset and sensitivity to the sun. Concerns about antibiotic resistance exist, but people argue that targeted doxyPEP use could reduce overall antibiotic usage.

Why are there delays around doxyPEP and NHS?

Antibiotic resistance fears and potential judgement towards sexual behaviour, especially among gay men, are barriers between doxyPEP and the NHS. This has raised questions as to why more concern is placed on doxycycline's use in LGBTQ+ individuals than in other populations.

Behind the scenes, efforts are underway for NHS adoption. The British Association for Sexual Health and HIV (BASHH) and the UK Health Security Agency are reviewing evidence, led by Dr John Saunders. Guidelines could be available in 2024, addressing concerns and allowing sexual health clinics to adopt doxyPEP.

While the NHS deliberates, individuals on social media are already sharing their doxyPEP experiences and stating how they believe it would be beneficial if implemented via the NHS.

Gerald Joseph, a therapist from Washington DC, has praised doxyPEP's transformative impact, which he has been accessing since July 2023. When speaking to inews, he stressed the need for wider access, emphasising the importance of sexual health empowerment.

Medically Reviewed by:
Dr. Alexis Missick MBChB. MRCGP
GMC reference no: 7151419
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Sources

• iNews - A Simple, Cheap Drug Could Prevent STIs

• BASHH - British Association for Sexual Health and HIV

• aidsmap - Doxycycline PEP After Sex Appears Ineffective