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PERSPECTIVE article

Front. Microbiol.

Sec. Antimicrobials, Resistance and Chemotherapy

Volume 16 - 2025 | doi: 10.3389/fmicb.2025.1616111

This article is part of the Research TopicIntegrating Health: a One Health Approach to Antimicrobial Resistance and Sustainable PracticesView all 3 articles

Where we stand on doxyPEP depends on where we sit: a viewpoint

Provisionally accepted
  • 1Institute of Tropical Medicine Antwerp, Antwerp, Belgium
  • 2The University of Melbourne, Parkville, Victoria, Australia
  • 3Toho University, Tokyo, Tokyo, Japan

The final, formatted version of the article will be published soon.

There is a striking variation in national doxycycline post exposure prophylaxis (doxyPEP) guidelines for sexually transmitted infections (STIs). Whilst some countries advocate doxyPEP for all men who have sex with men (MSM) and transgender women (TGW) with certain risks, others restrict the use to research settings. In this viewpoint, we argue that part of the explanation for this divergence can be attributed to different underlying conceptual frameworks. For individuals and organizations dominated by biomedical individualist frameworks, the primary goal of STI services is reducing the incidence of STIs. We have good evidence that doxyPEP does this and therefore, particularly in the setting of increasing STI incidence, this framework regards it as logical to roll out doxyPEP as fast as possible. By way of contrast, if organizations and their members operate within an ecosocial framework then their primary goal is the optimization of the sexual and overall health of individuals and populations and not just reducing STI rates. This framework sees the prevalence of STIs as being driven by the connectivity of local sexual networks. Recent increases in STI prevalence are seen as being due to increased network connectivity. The intensive use of antimicrobials such as doxycycline to reduce this prevalence is seen as introducing a selection pressure for the emergence of resistance to tetracyclines and other antimicrobials in N. gonorrhoeae and other species. The differences in these two frameworks thus leads different individuals with access to the same evidence-base to very different conclusions as to the net risk-benefit of doxyPEP.

Keywords: DoxyPEP, Doxycycline, STI - science, Chlamydia, gonorrhoea

Received: 22 Apr 2025; Accepted: 04 Jun 2025.

Copyright: © 2025 Kenyon, Vanbaelen, Kong, Kanesaka and Manoharan-Basil. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Chris Kenyon, Institute of Tropical Medicine Antwerp, Antwerp, Belgium

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