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October 05, 2023

To prevent STDs, the CDC wants some people to use a common antibiotic as a 'morning-after pill'

Studies suggest doxycycline drastically reduces the risk of chlamydia and syphilis among gay men, bisexual men and transgender women. Its effect among other groups needs more research

To reduce the spread of sexually transmitted diseases, the U.S. Centers for Disease Control and Prevention has proposed recommending a common antibiotic be taken after having unprotected sex.

Under the proposal, health care providers would offer doxycycline as a "morning-after pill" to gay men, bisexual men and transgender women who have had an STD within the last year or are at risk for one. The drug would be taken within 72 hours after having unprotected sex to lower the risk of contracting gonorrhea, syphilis or chlamydia.

The goal of the strategy is to reduce the risk of STDs among groups that are at high risk. The drug is being recommended for gay men, bisexual men and transgender women because studies suggest a single dose significantly cuts the risk of bacterial STDs among those groups. 

One of those studies, published in the New England Journal of Medicine, found the antibiotic reduced the risk of chlamydia and syphilis by at least 80% and gonorrhea by about 50%. 

The CDC recommendation may be expanded to include heterosexual cisgender men and cisgender women if research shows the strategy to be effective among them too, the New York Times reported. 

Doxycycline is commonly used to treat various bacterial infections. But it also can prevent them after exposure, a general strategy known as post-exposure prophylaxis and, in this specific case, as doxyPEP.

"DoxyPEP is moving STI prevention efforts into the 21st century," Jonathan Mermin, director of the CDC's National Center for HIV, Viral Hepatitis, STD and TB Prevention, told STAT News. "We need game-changing innovations to turn the STD epidemic around, and this is a major step in the right direction." 

Doxycycline may cause side effects including stomach pain, skin rashes, nausea, vomiting and loss of appetite. Some research has suggested the antibiotic is ineffective at preventing STDs in cisgender women. A recent study found that long-term use of doxycycline may contribute to bacteria resistance, allowing bacteria from STDs to defeat the drug used to kill it, which has left critics concerned about the potential risks of widespread use. 

In a document with research backing up its draft guidance, the CDC concluded that health care providers should utilize doxyPEP as part of a "comprehensive sexual health approach" that includes risk reduction counseling, STD screening and treatment, vaccinations and resources about HIV prevention or treatment. 

The proposal must undergo a 45-day public comment period before it is finalized. 

Health officials have warned about the rising rates of STDs. There were 2.5 million cases of gonorrhea, syphilis and chlamydia reported in 2021, according to the CDC's most recent data. Between 2020 and 2021, syphilis rates surged by 32% while gonorrhea and chlamydia rates each increased by about 4%. 

In 2022, Pennsylvania saw its highest rate of congenital syphilis — babies being born with the STD — in 32 years, with 22 cases reported in Philadelphia and 12 cases reported across the rest of the state. 

Gonorrhea, syphilis and chlamydia are all caused by bacterial infections and can be treated with antibiotics. Congenital syphilis is also curable with antibiotics, and pregnant women should be tested for the disease three times during pregnancy, according to a recommendation by the Philadelphia Department of Public Health. 

However, a lack of testing, sexual health clinic closures and a lack of public awareness about the prevalence of STDs have contributed to the rise in cases, PBS NewsHour reported. And though anyone can get an STD, some people are at higher risk. 

Teenagers and young adults account for half of STD cases, and Black adults account for about 35%. Gay and bisexual men also are disproportionately impacted, and almost 40% of those with syphilis also have HIV, which is caused by a virus, National Geographic reported. 

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