Will doxyPEP create antibiotic resistant STDs?

[marylander1940]

There’s a morning-after pill to prevent sexually transmitted infections

WWW.VOX.COM

---

Why aren’t more doctors prescribing it?

OP note: I don't think antibiotics should be taken unless they're needed. 

Edited April 18, 2023 by marylander1940

[+ BenjaminNicholas]

Bottom line, this is yet another tool in an arsenal.  And options are always a good thing.

As to resistance (as per Annie Luetkemeyer, M.D., a professor of medicine at University of California-San Francisco)

Quote

'Regarding antimicrobial resistance, Luetkemeyer reiterated that clinicians do not use doxycycline to treat gonorrhea, and there is no evidence of reduced efficacy against syphilis or chlamydia despite years of use. Krakower warned that increased antimicrobial resistance in the wake of doxyPEP might have a negative impact on clinicians’ ability to treat Neisseria and Staphylococcus infections, but Luetkemeyer pointed out that doxycycline is not used to treat serious Neisseria and Staphylococcus infections.'

The original article from TheBodyPro...

https://www.thebodypro.com/article/doxypep-stis-prophylactic-doxycycline-msm-hiv-prep

[Guest]

There are diseases, such as gonorrhea, which doxycycline won't treat. And doxycycline increases the risk of sun damage (including, probably cancer). Taking this for years on end hasn't been well-studied. People who sleep around a lot would be wisest to use to use PrEP and condoms, and get tested periodically. I haven't heard of any national advisory agency (comprised of public health officials), such as the USPSTF or CDC, recommending this. 

[+ BenjaminNicholas]

7 hours ago, Unicorn said:

There are diseases, such as gonorrhea, which doxycycline won't treat.

I literally already quoted this from the article, verbatim. 

But there are other drugs, like Ceftriaxone, which work quickly and easily on those who have contracted it. 

You don't have to practice DoxyPrep, but to say it's not useful as yet another choice would be fucking ridiculous. 

As for recommending agencies, the CDC has currently released formal considerations about it, while the San Francisco Department of Health has fully recommended it. 

That said, whether you're taking this as DoxyPrep or DoxyPep, it's not a regime that's right for everyone. 

Edited April 18, 2023 by BenjaminNicholas

[surferguy_1]

More people are getting on Doxypep. That's interesting since doctors in NY are still cautious about it. 

[+ KensingtonHomo]

It will contribute to antibiotic resistance. PreP for HIV makes sense to me, and I use it. But this is dangerous and, frankly, unnecessary. All the STIs are treatable, and if you're on Doxyprep, you're 99% likely to be on PreP. So why contribute to antibiotic resistance? We're not making new antibiotics and treatment-resistant gonorrhea is on the rise. 

[+ BenjaminNicholas]

2 hours ago, KensingtonHomo said:

It will contribute to antibiotic resistance. PreP for HIV makes sense to me, and I use it. But this is dangerous and, frankly, unnecessary. All the STIs are treatable, and if you're on Doxyprep, you're 99% likely to be on PreP. So why contribute to antibiotic resistance? We're not making new antibiotics and treatment-resistant gonorrhea is on the rise. 

Did you not read what was posted above?  Gonorrhea isn't even treated with the class of antibiotic that doxy is in.  It's really a moot point.

Antibiotic resistance is per class of specific drug.  At longer-term low dosage doxy, the resistance level is incredibly low.  It's nearly zero when you follow a more conservative doxyprep regime of only taking it post-72 hours from last sexual activity.

This is a shades of grey discussion.  Blanket statements are harmful to those who could benefit from this regime.  You're in a sex-worker/sex-positive forum here and for many of us, this is a helpful medical discussion to have with our doctors.

[+ KensingtonHomo]

7 minutes ago, BenjaminNicholas said:

Antibiotic resistance is per class of specific drug.  At longer-term low dosage doxy, the resistance level is incredibly low.  It's nearly zero when you follow a more conservative doxyprep regime of only taking it post-72 hours from last sexual activity.

I am incredibly pro-sex worker, but you do not understand antibiotic resistance. We have a massive overuse of antibiotics in this country (and globally), 20-60 percent of which are not medically necessary. Resistance does not happen in our bodies. It happens to the bacteria as they are exposed to drugs and evolve to survive them. All antibiotic use contributes to resistance. I generally support sex workers using them, but all sexually active gay men going on DoxyPrep is a terrible idea for public health. As people who have lived through three plagues in our lifetimes - two of which disproportionately impacted us - we need to be community-minded in approaching our individual and collective health. 

"On an individual and population level, drug resistance will likely occur with the increased use of Doxy PEP, especially with the amount of doxycycline that will be indicated for many users. The extent to which this happens, and the impact, are still open questions, and must be carefully monitored." 

 

Drug resistance and Doxy PEP: Should we worry? - San Francisco AIDS Foundation

WWW.SFAF.ORG

---

In late 2022, the San Francisco Department of Public Health and San Francisco AIDS Foundation began...

 

[+ BenjaminNicholas]

13 minutes ago, KensingtonHomo said:

I am incredibly pro-sex worker, but you do not understand antibiotic resistance. We have a massive overuse of antibiotics in this country (and globally), 20-60 percent of which are not medically necessary. Resistance does not happen in our bodies. It happens to the bacteria as they are exposed to drugs and evolve to survive them. All antibiotic use contributes to resistance. I generally support sex workers using them, but all sexually active gay men going on DoxyPrep is a terrible idea for public health. As people who have lived through three plagues in our lifetimes - two of which disproportionately impacted us - we need to be community-minded in approaching our individual and collective health. 

"On an individual and population level, drug resistance will likely occur with the increased use of Doxy PEP, especially with the amount of doxycycline that will be indicated for many users. The extent to which this happens, and the impact, are still open questions, and must be carefully monitored." 

 

Where did I say that resistance happened in our bodies?  I promise you I didn't.

I also never said or implied that 'all' sexually active gay men need to be on doxyprep.  I said it was simply one tool in an arsenal.

I do fully understand antibiotic resistance.  

I don't disagree that resistance is becoming more of an issue in society, but for a sex worker or someone who's putting themselves at a higher risk, you have to weigh your options and risk factors.  

I appreciate this discussion.  It's an important thing to keep on top of around here.

Edited May 15, 2023 by BenjaminNicholas

[Guest]

2 hours ago, BenjaminNicholas said:

...for a sex worker or someone who's putting themselves at a higher risk...

Or, how about PrEP and condoms... 🙄

[marylander1940]

6 hours ago, Unicorn said:

Or, how about PrEP and condoms... 🙄

Guys use PrEP in order NOT to use condoms, it's a fact Doctor!

[+ BenjaminNicholas]

33 minutes ago, marylander1940 said:

Guys use PrEP in order NOT to use condoms, it's a fact Doctor!

Many, yes, but not always. 

Condoms are still an important part of the equation. 

[Guest]

2 hours ago, marylander1940 said:

Guys use PrEP in order NOT to use condoms, it's a fact Doctor!

Maybe some guys use PrEP because 99.7% efficacy at preventing HIV is better than 80-90% (condoms). 99.9+% efficacy if you use both. And condoms help protect against a whole lot of other stuff. 

[KeepItReal]

When I see articles like this, it makes me wonder...

https://arstechnica.com/science/2024/03/super-gonorrhea-rate-quickly-triples-in-china-now-40x-higher-than-us/

[+ BenjaminNicholas]

2 hours ago, KeepItReal said:

When I see articles like this, it makes me wonder...

https://arstechnica.com/science/2024/03/super-gonorrhea-rate-quickly-triples-in-china-now-40x-higher-than-us/

I recommend never having sex again.

Find a comfortable plastic bubble and settle in.

[KeepItReal]

43 minutes ago, BenjaminNicholas said:

I recommend never having sex again.

Find a comfortable plastic bubble and settle in.

A for effort in slinging sarcasm. F for failure to show empathy to other sex workers. 

Edited March 31 by KeepItReal
Gif added

[+ BenjaminNicholas]

On 3/31/2024 at 10:26 AM, KeepItReal said:

A for effort in slinging sarcasm. F for failure to show empathy to other sex workers. 

Just one question professor...  Is this class grading on an average?

[marylander1940]

I know who take DoxyPep after seeing a guy taking loads at a hotel once or twice per year but would never abuse taking the pill every single week. 

 

[+ Tygerscent]

I have also been wondering about this… Intermittent, incorrect usage of Doxy, or being exposed to syphilis, chlamydia or gonorrhea when the levels of Doxy are low in your system, just seems like an opportunity for those bacteria to multiply and mutate into something monstrously resistant to anything we currently have~   Aren’t resistant variations of these diseases already on the rise despite our use of available medication’s treating them?  
 I also wonder about the effects of taking doxycycline on a daily basis for those who want to go that route. Perhaps taking only that medication on a daily basis, it’s not a problem, but, so many people actually take other medication’s, as well as artificial flavors, artificial colors, food, preservatives and live in areas with toxic water and toxic air and toxic land. Some honest part of me  Has great hesitance. Is this really somehow less expensive than just going in for a quarterly STI screening? Discovy makes sense to me… The Doxy has me uncertain~
 The past two years have already present themselves with the ugly picture of a penicillin shortage which affected how and who, with syphilis, was treated in various parts of the world. Losing the effectiveness of doxycycline, and maybe potentially running into a shortage at some point just seems like, silence of the lambs two waiting to happen~ whatever that means…  

[+ Tygerscent]

On 5/15/2023 at 10:51 PM, Guest said:

Maybe some guys use PrEP because 99.7% efficacy at preventing HIV is better than 80-90% (condoms). 99.9+% efficacy if you use both. And condoms help protect against a whole lot of other stuff. 

Unfortunately, condom break, condom, slip off during, and after orgasm, alms can leak, people can spill the contents of condoms on their partners on purpose, or by accident… People don’t use condoms for oral sex, which can likewise spread pretty much any disease that condoms are trying to prevent. Sex is a dirty, messy and beautiful thing. It’s the reason anyone of us is here at all~ There are risks to sex, even if it’s just you having it by yourself~ it’s amazing what in reality people put where by themselves in their own time. Hormones motivate creativity whether alone or with a partner or many partners.  There’s actually risk to not having sex: potentially an elevated risk for prostate cancer, changes in cortisol levels, sleep disturbances, psychological and/pr emotional distress~ 
 Despite not being perfect individuals, people do have the option, and in general potential for exercising good judgment, whether they are using condoms or not using condoms, using or not using prep… Personal responsibility and common sense can go a long way~    
 It seems somehow at least questionable if not an obvious caution to place the responsibility of safety, on either condoms or other prophylaxis when it comes to sex. Plenty of babies and STI are passed along any of it.

[Luv2play]

On 4/18/2023 at 2:09 AM, Guest said:

There are diseases, such as gonorrhea, which doxycycline won't treat. And doxycycline increases the risk of sun damage (including, probably cancer). Taking this for years on end hasn't been well-studied. People who sleep around a lot would be wisest to use to use PrEP and condoms, and get tested periodically. I haven't heard of any national advisory agency (comprised of public health officials), such as the USPSTF or CDC, recommending this. 

As of June this year the CDC has now recommended that for a certain subset of gay men who have sex with other men, DoxyPep as a post exposure form of treatment to reduce significantly the risk of transmission of syphilis, gonorrhea and chlamydia, especially syphilis where over 90% reduction has been observed in open label randomized trials (lesser but still significant numbers over 50% for other STIs).

British Columbia in Canada has also endorsed this new form of protection against SDIs and it is available in other jurisdictions such as Ontario if a doctor prescribes it. I approached my doctor yesterday and he gave me a prescription. In the past I have had syphilis twice, once over 40 years ago in my youth and more recently from a provider who gave me a heads-up after he tested positive  a month after I had seen him.

I saw a provider last weekend and he was on DoxyPep and generously gave me two of his pills (200mg) which prompted me to see my doctor.

This is an evolving story and more people need to get up to speed on it if they have sex with other men.

[KeepItReal]

I would advise caution and a long conversation with your doctor. Specifically about side effects. My doctor told me that ongoing use of doxi can impact bone density and discolor teeth etc. Shared some studies with me. Ask questions and make an informed decision. 

[Luv2play]

2 hours ago, KeepItReal said:

I would advise caution and a long conversation with your doctor. Specifically about side effects. My doctor told me that ongoing use of doxi can impact bone density and discolor teeth etc. Shared some studies with me. Ask questions and make an informed decision. 

There is a distinction between DoxyPeP and DoxyPrep. The latter is daily use of the drug like PreP for avoiding HIV. 
The former about which I am talking is a morning after pill only used after an interaction either oral or anal when one feels one might have been exposed to an STI. This does not constitute daily or regular use for a client such as myself. 
It is different for providers who see clients on a regular basis. 

[SirBillybob]

Yes, the recent CDC DoxyPEP guidelines are specific to MSM/TGW that actually acquired a STI within the previous year. There is yet to be devised an official standard of care for those not in that category. But in Canada I believe either scenario is ‘off label’. 

Not surprised at the BC news because Grennan is running the DISCO trial out of there. Those results will be quite a while coming out.

What accounts for non-USA jurisdictions’ reticence to emulate the current guidelines may be related to a different take on the efficacy evidence to date and to a different way of handling the risk behaviours that generate STI incidence. 

I read the news about BC and thought it was less than fully responsible. The majority of global Infectious Diseases entities are rightfully tentative. 

DoxyPEP efficacy against Gonorrhea is since revised downward when synthesizing the relevant data, and that update was available months before the final CDC summary. Moreover, along with low effectiveness is a high rate of Gonorrhea infection among recipients of DoxyPEP that would be expected to occur among populations with the same risk as study participants, that is, a previous STI infection essentially serving as a benchmark for sexual activity that supports statistical analysis comparing prophylaxis to placebo. 

The rates of Gonorrhea while on DoxyPEP are consistently greater than the rates of Syphilis and Chlamydia when not taking it. 

The guidelines gloss over the likelihood of breakthrough Gonorrhea in spite of attempted prophylaxis. Similarly, the growing rate of Gonorrhea antimicrobial resistance to conventional treatment (i.e., Ceftriaxone) is downplayed. 

The takeaway from the guidelines among some Infectious Diseases stakeholders is that prospective candidates for DoxyPEP are unfairly considered to be poorly equipped to process information related to differing efficacy data across the targeted infections and that it is futile to educate about problematic incidence rates because transmission will occur anyway. In fact, as seen with MPox for example, folks can and will adjust behaviour when given accurate information, while maintaining self-determination. 

The few jurisdictions endorsing DoxyPEP are telegraphing cynicism while virtue-signalling support for importance of personal sexual autonomy. You can also detect this in a recent conference rapporteur summary when referencing the recent disappointing updates about Gonorrhea. They are falling short of a transparent rendering of the advantages and liabilities of DoxyPEP. Be an ally fully, not half-measured.

I wouldn’t say to anybody that DoxyPEP is a legitimate 3-for-1. Subtracting to 2-for-1 essentially calls for condom protection or other harm reduction with respect to Gonorrhea specifically. If you are not fine with trading off avoidance of Gonococcal infection, that is regrettably refractory to treatment, for the irrefutable benefit of pharmacological protection from Syphilis and Chlamydia (both of which are treatable) then Doxycycline prophylaxis is already obsolete. 

It is virtually impossible to stratify behavioural approaches to STI prevention according to the above differences among bacterial infections due to commonality in the routes of transmission. Gonorrhea is the more problematic STI but unfortunately evades prophylaxis.

Edited August 13 by SirBillybob

[+ newatthis]

23 hours ago, SirBillybob said:

The rates of Gonorrhea while on DoxyPEP

Your use of such phrases makes me wonder whether you're writing about "PrEP" rather than "PEP"...can one really describe someone as "being on DoxyPEP"?  Could you clarify?  Also, it would be helpful if you could include links to the studies you refer to.  Thanks.