In Focus

Beyond condoms: A pill after sex to prevent STIs


The recommendation of doxycycline as an after-sex antibiotic is based on studies demonstrating that a single dose of the antibiotic, taken within 72 hours of act, significantly reduces the risk of infection

The Centers for Disease Control and Prevention (CDC) plans to recommend the use of the antibiotic doxycycline as a preventive measure after unprotected sexual encounters, but only for specific groups at higher risk.

The proposed strategy, called doxy-PEP, will target gay and bisexual men and transgender women who have either had an STI within the past year or are at risk of contracting one. 

The CDC, however, acknowledges that the scientific evidence supporting this approach is limited, and it is not being recommended for all individuals potentially exposed to infection-causing bacteria during sexual encounters. The agency has released draft guidelines and intends to finalize them after a 45-day public comment period.

Alarming spike in STIs

The urgency behind this move stems from the alarming increase in STI cases. In 2021, the United States saw 1.6 million cases of chlamydia, over 700,000 cases of gonorrhea, and nearly 177,000 cases of syphilis, incurring direct medical costs of approximately $1.1 billion. Cases of syphilis in newborns also surged in that year, affecting nearly 3,000 infants.

All three of these STIs are bacterial and can be effectively treated with antibiotics. However, the closure of sexual health clinics across the country and reduced public awareness have contributed to the sharp rise in infections.

Gonorrhea cases have increased by 118 percent since 2009, and syphilis, which was almost eliminated two decades ago, has seen a 74 percent increase since 2017. The CDC estimates that on any given day in 2018, approximately one in five Americans had an STI.

The CDC’s recommendation of doxycycline is based on studies demonstrating that a single dose of the antibiotic, taken within 72 hours of unprotected sex, significantly reduces the risk of infection. 

Some cities, such as San Francisco, have already been offering doxy-PEP to individuals at high risk of infection for several months. Patients are typically given a supply of pills and instructed to take one within three days of a potentially risky encounter.

Dr Jonathan Mermin, director of the agency’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention told New York Times in an emailed statement that recommending use of doxycycline was an important step to address the STI epidemic. 

Also Read: ‘Intimacy, healthy lifestyle key to better sex life, not superfoods’