Doxy-PEP – Your Questions Answered!

You may have heard of PEP but what about Doxy-PEP? We’ve been getting plenty of questions about this new option, so we’ve put together some responses to help you better understand this new STI prevention tool.

What is Doxy-PEP?

Doxy-PEP is a new option for reducing sexually transmitted infections (STIs). Doxy-PEP involves taking an antibiotic called doxycycline after sex to protect against STIs, specifically syphilis and chlamydia.

Doxycycline is an antibiotic that is widely used to treat a range of bacterial infections and to control other conditions such as acne, and to prevent malaria.

That being said, Doxy-PEP isn’t for everyone, check out who benefits most below.

Who benefits the most from taking Doxy-PEP?

Clinical trials have shown that Doxy-PEP is most likely to benefit people at higher risk of syphilis, such as gay and bisexual men, other men who have sex with men and transgender women. The greatest benefit would be for those who have had a recent syphilis diagnosis or have had multiple STIs in the recent past.

You might consider using Doxy-PEP if you’re expecting an upcoming period when you’ll have more sex, such as a sex event, or a holiday that is likely to involve sex with multiple casual sexual partners.

How effective is Doxy-PEP?

Doxy-PEP use reduces the risk of syphilis (by 70-80%) and chlamydia (by 70-90%) in gay, bisexual and other men who have sex with men. Doxy-PEP is unlikely to be effective against gonorrhoea due to antimicrobial resistance. It does not protect against viral infections such as HIV or herpes.

How do I make a decision about whether Doxy-PEP is right for me?

There are many ways to prevent STIs, Doxy-PEP is just one approach. To work out if Doxy-PEP is the most suitable approach for you it’s a good idea to have an open discussion with your doctor about your individual circumstances.

The following benefits and risks can be useful factors for decision making.

Potential benefits of Doxy-PEP:

• Support prevention of syphilis (which can have serious health complications) and chlamydia
• Help reduce the STI spread in your sexual network
• Adds protection alongside other STI prevention strategies such as condoms and STI testing.

Potential risks of Doxy-PEP:

• Your skin may become more sensitive causing rash or sunburn
• Although rare, you may have an allergic reaction, or what is called an oesophageal ulceration (a painful sore in the lining of the lower part of the oesophagus) or liver damage.
• Using Doxy-PEP may lead to your body becoming resistant to antibiotics. If many people use it, it could cause gonorrhoea to become harder to treat in the community. This could make it more difficult to treat STIs and other infections in the future.

It’s important to consider both the potential benefits, especially preventing serious complications of syphilis, and the possible risks of Doxy-PEP when choosing the best STI prevention strategy for your current situation.

Why Doxy-PEP and not Doxy-PrEP (as in, why not take it before sex)?

It’s not usually recommended to take daily doxycycline (100mg) as a prevention method, because it leads to more antibiotic use and can increase the risk of antibiotic resistance (your body becoming resistant to antibiotics).

How do I take Doxy-PEP?

Your doctor/GP can provide you with instructions on how to take Doxy-PEP.

Taking Doxy-PEP involves:

• Taking 200mg of doxycycline (usually two 100mg tablets) within 72 hours (3 days) after sex.
• It is not recommended to take Doxy-PEP more than once every 3 days. If you have sex multiple times over a weekend, you would take a single dose within 72 hours (for example on Monday).

Some useful information on taking Doxy-PEP:

• take with a full glass of water, or a glass of milk or food
• avoid lying down for at least half an hour after swallowing your tablet to prevent irritation to the food pipe
• side effects include headaches, nausea and vomiting, skin being more sensitive to sunlight (sunburn).

Are Doxy-PEP and HIV PEP/PrEP safe to take together?

Yes. Doxycycline can be taken at the same time as HIV PEP and HIV PrEP as doxycycline does not work against viral infections such as HIV, its’ a good idea to discuss HIV prevention options such as HIV PrEP with your doctor as well.

If I am on Doxy-PEP, how often should I get an STI test?

It’s recommended that you visit your doctor every 3 to 6 months for STI testing and to assess if you need to keep using it.

How do I access Doxy-PEP?

You can access Doxy-PEP from a doctor/GP.

SHINE SA doctors can prescribe Doxy-PEP, as do most HIV medication prescribing GPs (S100 prescribing GPs). If your doctor is not familiar with Doxy-PEP, you can share the NSW Health Doxy-PEP decision aid.

Your doctor will help you make an informed decision about whether Doxy-PEP is the best for you based on your individual circumstances and needs.

Are you a health professional?

You can access more information on Doxy-PEP via the ASHM Doxy-PEP Decision Making Tool.

Health professionals can also call SHINE SA’s Sexual Healthline. The Sexual Healthline is open Monday – Friday, 9:00am – 12:30pm, call 1300 883 793.