CDC recommends queer men & trans women take a morning after pill to prevent STIs

The Centers for Disease Control are recommending widespread use of a common antibiotic as a morning-after pill to battle the growing scourge of STIs among gay and bisexual men and transgender women.

Guidelines from the CDC published on Monday propose health providers offer doxycycline to men who have sex with men, and trans women, within three days of having unprotected sex in a formulation commonly known as doxy PEP (or post-exposure preventative).

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“From 2011-2021, reported STIs have increased 42 per cent, with more than 2.5 million cases in 2021 alone,” Dr. Jonathan Mermin, the director of the CDC’s National Center for HIV, Viral Hepatitis, STD and Tuberculosis Prevention posted to X on Monday along with the announcement.

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Pleased to announce the draft guidelines for doxycycline (doxy) as post-exposure prophylaxis (PEP) for STIs. #HCPs & members of communities heavily affected by #STIs, share your input 👉 https://t.co/q6NSGWuuL4

Here are 5 reasons why the U.S. needs #doxyPEP guidance (1/6): pic.twitter.com/HBMvK8MlM5

— Dr. Jono Mermin (@DrMerminCDC) October 2, 2023

The new guidelines are based on four major studies of using doxycycline against bacterial STDs.

One New England Journal of Medicine study this year found that at-risk populations with previous STD infections were roughly 90% less likely to get chlamydia, 80% less likely to get syphilis and more than 50% less likely to get gonorrhea compared with people who did not take doxy PEP after sex.

The inexpensive antibiotic has been available for more than 40 years and is commonly used to treat acne, chlamydia and Rocky Mountain spotted fever. The drug’s side effects include stomach problems and rashes after sun exposure.

The new guidance follows a small number of healthcare providers employing the drug as a post-exposure preventative with success. San Francisco’s health department began promoting doxycycline as a morning-after prevention measure more than a year ago.

With infection rates rising, “we didn’t feel like we could wait,” Dr. Stephanie Cohen, who oversees the department’s STD prevention work, told the AP.

In Boston, Fenway Health, which serves a population of LGBTQ+ clients, has about 1,000 patients using doxycycline as a post-exposure preventative, said Dr. Taimur Khan, the organization’s associate medical research director.

Khan said the new guidance should have a big impact because some doctors may have been reluctant to prescribe the treatment before the CDC weighed in.

While great strides have been made in STD prevention, including the HPV vaccine and PrEP for HIV,  common STDs are “a field that’s lacked innovation for so long,” says Mermain. Modeling data suggests that prescribing doxy PEP could avert about 40% of STIs in at-risk populations.

“If doxy PEP is delivered equitably,” says Mermain, “this may help us bring down the toll of STIs among people who are disproportionately affected by these infections while we continue to search for other needed tools.”

Widespread use of doxycycline as a preventive could, in theory, contribute to mutations that make bacteria resistant to the drug, said Dr. Cohen at San Francisco’s health department, though she hasn’t seen it yet.

It will be important to watch for, she added.