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A study conducted by Rifa Ehsan, MPH 2024, Alexa D’Angelo, doctoral candidate, and Christian Grov, professor and chair of Community Health and Social Sciences aimed to explore gay and bisexual men’s (GBM) perceptions about doxycycline post-exposure prophylaxis (Doxy-PEP) as means of preventing sexually transmitted infections. Little is known about the acceptability of this nascent prevention strategy in the U.S., nor how best to engage those most vulnerable to STIs in taking up this nascent prevention strategy.
According to the CDC, bacterial sexually transmitted infections (STIs) remain a significant public health concern. They can be treated and cured with antibiotics, but left untreated, STIs can have serious long-term health consequences. GBM experience disproportionately high rates of sexually transmitted infections. Additionally, active syphilis, chlamydia or gonorrhea increases vulnerability to acquiring HIV.
Doxy-PEP involves taking 200 mg of doxycycline within 24 hours after condomless oral, anal, or vaginal sex. This strategy significantly reduces the risk of acquiring bacterial STIs. Doxycycline is an FDA approved broad-spectrum antibiotic that has been available on the market since the early 1960s. In October of last year, the CDC released draft guidelines for Doxy-PEP, and several clinics throughout the U.S. have already begun prescribing it as an STI prevention strategy. However, Doxy-PEP as a STI-prevention strategy is not currently FDA-approved, and official CDC guidelines for its use are still forthcoming.
This study used data collected in the Together 5000 (T5K) study, a U.S. national internet-based cohort study of over 5000 GBM. The team conducted 24 in-depth qualitative interviews with participants in the cohort. Interview questions addressed whether the interviewees had heard about Doxy-PEP, if they were interested in it as a strategy, and any concerns they might have about its use.
Participants were generally interested in using Doxy-PEP, but were concerned about the potential for antibiotic resistance, side-effects, and medication interactions, along with stigmatizing discourse around its use. Meanwhile, participants were motivated by the simplicity of Doxy-PEP and the protection it could confer on both an individual and community-level— as well as its potential to reduce STI-related anxiety. Finally, participants desired additional information on Doxy-PEP to address their concerns.
“As the CDC works on rolling-out official Doxy-PEP guidelines, it is evident that there is a need for clear guidelines and expanded public health messaging on Doxy-PEP in the U.S.,” says first author Ehsan. “Our study leverages qualitative data to explore GBM’s perceptions about Doxy-PEP, and these data have the potential to play an important role in informing interventions and policies aiming to implement Doxy-PEP, especially among GBM who continue to experience a high burden of STIs.”
“Thus far, randomized control studies of Doxy-PEP are exceptionally promising, such that several departments of health are already encouraging people to start using it despite a lack of formal endorsement by the CDC or guidance from the FDA,” says senior author Grov. “Conducting a qualitative study on people’s knowledge about and attitudes toward Doxy PEP now is critical before we see wide scale rollout. If we want to optimize uptake, we need to understand whether people will use this strategy, what concerns they have, and how to message effectively.’”
This study stems from Ehsan’s MPH capstone project in the Department of Health Policy and Management (HPAM), and its publication is a testament to her excellence as a student. She has been selected for the HPAM Departmental Dean’s Award, which will be presented to her at the CUNY SPH commencement ceremony this June at the Apollo Theater.
Rifa Ehsan, Alexa B. D’Angelo, Drew A. Westmoreland, Christian Grov. Perceptions about doxycycline post-exposure prophylaxis (Doxy-PEP) as an STI-prevention strategy among gay and bisexual men (GBM) in the United States: Results from a qualitative study. Preventive Medicine, 2024,107977, ISSN 0091-7435, https://doi.org/10.1016/j.ypmed.2024.107977
