Will doxyPEP create antibiotic resistant STDs?

[SirBillybob]

1 hour ago, newatthis said:

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.

I see. Good point. I am only referring to PEP.

I think “on” and “taking” can be interchangeable, even if regularly or prn.

But I understand that for some “on” connotes taking regularly.

The thing is that either DoxyPEP (theoretically on-demand) or DoxyPrEP (theoretically daily) can merge in regularity, obviously in contrast to HIV PrEP and HIV PEP. The caveat is Doxy dosage, never more than 200 mg in any 24-hr period. Technically, like HIV on-demand PrEP (a ‘before’ risk scenario) Doxy STI prophylaxis uptake quantity and frequency is variable in either a ‘before’, ‘after’, or blend of each. 

——

There is a fair abundance of Gonorrhea discussion, ‘up thread’ or ‘up topic’ as the kids say, under Health here, or a quick Google search will steer you to reputable summaries albeit a bit outdated on research developments. I had tried to fill in some of the gaps past while. The updated (downgraded) DoxyPEP effectiveness presented at the 2024 CROI conference seems to have not yet made it to journal publication. The integration of Ceftriaxone treatment failure reality has also fallen short in health entity summaries and there is more upthread on antimicrobial resistance (AMR).

The only research on DoxyPrEP is a decade old and it was not effective for Gonorrhea. You can access that reference any many others from the CDC DoxyPEP guidelines simply by using the word search function for PrEP though you will see most of the yield relates to HIV PrEP.

Edited August 14, 2024 by SirBillybob

[SirBillybob]

Here’s the updated French IPERGAY/DOXYVAC research I mentioned wrt CROI meeting and an earlier post of mine. They actually omitted the Gonorrhea DoxyPEP results. I cannot access the full text without paying for Lancet subscription, so passing. 

Just a moment...

WWW.THELANCET.COM

 

Edited August 14, 2024 by SirBillybob

[SirBillybob]

From 2024 CROI meeting, DoxyVAC efficacy for Gonorrhea adjusted down to 33% efficacy from interim 51%. But the incidence curves merge so it has to be even less. In contrast, you can see the incidence curves separating widely for Syphilis and Chlamydia. They omitted recurrent GC infection in the hazard ratio metric. Recurrence not uncommon due to high GC rates over time. They omitted these revisions from subsequent Lancet publication. The entire component was ghosted and, therefore, will be excluded from any meta-analytic synthesis of the small extant body of research. 

The incidence difference is statistically significant but of questionable clinical significance because 40% of study subjects allocated to PEP were infected with Gonorrhea over the study period and the curve direction portends higher cohort rates over time.

15% of subjects not taking PEP caught Syphilis. 

Edited August 14, 2024 by SirBillybob

[Luv2play]

5 hours ago, newatthis said:

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.

Also  I don’t understand Sir Billy Bob’s reference to few jurisdictions endorsing DoxyPeP when the CDC represents the entire USA. 

[Bokomaru]

I’d just like to note a correction to this thread. Doxy is indeed used to treat gonorrhea sometimes. In fact a friend of mine was treated this way just last month. It’s sometimes done when there is a concurrent chlamydia infection, which was his case. 
 

As for the pluses and minuses of doxy pep/prep, it’s not entirely clear. What I do know is that my Midtown Manhattan GP has tons of gay patients. He is very conservative about antibiotic use yet he believes doxy pep benefits outweigh the risks. 
 

Do your own research, sure. But please, ask a doctor who is familiar with your particular situation and risk category. 

[Luv2play]

What I like about the DoxyPep regime is that it is a very effective way of avoiding contracting syphilis, which is if left undetected and untreated, much more serious in terms of health outcomes.

[SirBillybob]

I have enjoyable encounters without STI risk, so what I have done is fill in some of what I perceive to be missing elements in the decision-making process for DoxyPEP use. I don’t have much skin in this game.

There is some interesting reading on other jurisdictions’ reviews and perspectives on DoxyPEP validity should you be interested, use search terms such as Europe, EU, Australia. Generally thumbs down from majority proportions of working groups. 

I test for STIs regularly, even though risk is negligible for me, because there tends to be openness with partners regarding status. I wouldn’t take DoxyPEP even if its current prophylaxis record were to be better for Gonorrhea, the reason being that any of the 3 infections would be detected early in the extremely unlikely event of acquiring one and, similarly, behavioural risk mitigation transfers into partners’ negligible risk from interacting with me.

I would follow national guidelines for treatment if I ever acquired Gonorrhea: Ceftriaxone. AMR is creeping up for this drug but remains less than for Doxycycline. Test of cure is a possible contingency for following any treatment failure with a back-up medication. An anecdotal case of Doxy success is not surprising, in the same way that outright ineffectiveness of PEP is refutable, but does not figure prominently in guidance predicated on the broader picture of best GC treatment practice. 

Happy sex and ‘bonne chance’.

Edited August 14, 2024 by SirBillybob

[Luv2play]

23 minutes ago, SirBillybob said:

I have enjoyable encounters without STI risk, so what I have done is fill in some of what I perceive to be missing elements in the decision-making process for DoxyPEP use. I don’t have much skin in this game.

There is some interesting reading on other jurisdictions’ reviews and perspectives on DoxyPEP validity should you be interested, use search terms such as Europe, EU, Australia. Generally thumbs down from majority proportions of working groups. 

I test for STIs regularly, even though risk is negligible for me, because there tends to be openness with partners regarding status. I wouldn’t take DoxyPEP even if its current prophylaxis record were to be better for Gonorrhea, the reason being that any of the 3 infections would be detected early in the extremely unlikely event of acquiring one and, similarly, behavioural risk mitigation transfers into partners’ negligible risk from interacting with me.

I would follow national guidelines for treatment if I ever acquired Gonorrhea: Ceftriaxone. AMR is creeping up for this drug but remains less than for Doxycycline. Test of cure is a possible contingency for following any treatment failure with a back-up medication. An anecdotal case of Doxy success is not surprising, in the same way that outright ineffectiveness of PEP is refutable, but does not figure prominently in guidance predicated on the broader picture of best GC treatment practice. 

Happy sex and ‘bonne chance’.

Your sensible comments just reinforce the need for each of us to assess our own situation and practices. One size does not fit all. 

[moonlight]

DoxyPEP is something I've debated for a while, for myself. I decided against it but I'm glad the option exists.

Personally I don't see much benefit to taking it. If I get a symptomatic STI, I'll get immediate treatment. If I get an STI that's asymptomatic, I would assume it would show up on my quarterly PrEP testing. So it seems like the benefit of it is decreasing the risk of an asymptomatic infection that somehow bypasses regular testing (seems unlikely) and also decreased chances of having to deal with the initial but temporary pain of a curable STI.  I'll pass that up over not having to pop an antibiotic regularly which itself can have side effects, and which may not prevent the infection in the first place.

I suppose there's also a decreased risk of passing on an STI with DoxyPEP, but to be honest that's not top of mind for me since PrEP/DoxyPEP/condoms are an option for us all and we each do that calculus for ourselves, based on our own health and risk preferences.

I'm all ears if anyone thinks my personal reasoning is flawed.

Edited August 15, 2024 by moonlight

[SirBillybob]

2 hours ago, moonlight said:

I’m all ears if anyone thinks my personal reasoning is flawed.

Just the part about how that works out with Magnums, as well as the bioavailability of antibacterial treatment with all that cartilage. 😉

Edited August 15, 2024 by SirBillybob

[SirBillybob]

An interesting read attached. So disappointed Aidsmap is done.

Dissent on doxyPEP: recent guidelines becoming more cautious | aidsmap

WWW.AIDSMAP.COM

---

Two recent statements about taking the antibiotic doxycycline up to 72 hours after sex to prevent bacterial sexually...

 

[SirBillybob]

If you like your STIs in even-number clusters of four better than odd-number clusters of three, you might look up MGen (MG) infection and DoxyPEP as well as AMR associated MGen. It was included, for example, in the IPERGAY study and significant PEP protection did not occur. Another glossed over bacterial STI entity. 

Go to the party for Syphilis and Chlamydia reduction benefits, stay for the Gonococcal and Mycoplasma Genitalium shots. 
 

Do you want to live in a world where two highly problematic STIs become irrelevant factors in the prophylaxis research literature and are dismissed in subsequent guidance simply because they were included but no salutary benefit was found? I don’t. 

Edited August 15, 2024 by SirBillybob

[SirBillybob]

3 hours ago, moonlight said:

DoxyPEP is something I've debated for a while, for myself. I decided against it but I'm glad the option exists.

Personally I don't see much benefit to taking it. If I get a symptomatic STI, I'll get immediate treatment. If I get an STI that's asymptomatic, I would assume it would show up on my quarterly PrEP testing. So it seems like the benefit of it is decreasing the risk of an asymptomatic infection that somehow bypasses regular testing (seems unlikely) and also decreased chances of having to deal with the initial but temporary pain of a curable STI.  I'll pass that up over not having to pop an antibiotic regularly which itself can have side effects, and which may not prevent the infection in the first place.

I suppose there's also a decreased risk of passing on an STI with DoxyPEP, but to be honest that's not top of mind for me since PrEP/DoxyPEP/condoms are an option for us all and we each do that calculus for ourselves, based on our own health and risk preferences.

Theoretically, there’s also the population-level effects of Doxy prophylaxis, beyond self and intimate others. If the majority of higher at-risk GBMSM that go condomless simultaneously pursued uptake with high adherence levels over an arbitrary period of time it could attenuate two bacterial STIs, dramatically reducing incidence by controlling prevalence.

To some degree that could compensate for poor control of the other two bacterial diseases. The latter would necessitate an arbitrary period of protected sex for the population majority; limited-time mass adjustment not abstinence. We cannot rule out that gaming Gonorrhea will eventually require such an intervention even though now would be ideal. It would cut incidence along with putting the brakes on AMR. 

Edited August 15, 2024 by SirBillybob

[marylander1940]

Doctors recommend restricting the use of antibiotics in a preventive way and exclusively for post infection treatment.

 

Superbugs Could Kill 39 Million People by 2050 Says Study

TIME.COM

---

The estimates come from a landmark new study published in the Lancet, the first global analysis of antimicrobial resistance trends.

 

[Luv2play]

9 hours ago, marylander1940 said:

Doctors recommend restricting the use of antibiotics in a preventive way and exclusively for post infection treatment.

 

Superbugs Could Kill 39 Million People by 2050 Says Study

TIME.COM

---

The estimates come from a landmark new study published in the Lancet, the first global analysis of antimicrobial resistance trends.

 

I’ll be dead by 2050. So I saved myself the trouble of reading beyond the first paragraph. 

[CuriousByNature]

On 9/17/2024 at 3:36 PM, Luv2play said:

I’ll be dead by 2050. So I saved myself the trouble of reading beyond the first paragraph. 

Don't be so sure!

[Luv2play]

1 hour ago, CuriousByNature said:

Don't be so sure!

I agree with Betty White but even she didn’t make 100. And I would be 103 in 2050.

[CuriousByNature]

16 minutes ago, Luv2play said:

I agree with Betty White but even she didn’t make 100. And I would be 103 in 2050.

She came close... pretty much got to see her birthday cake being baked, but never got to blow out the candles.

And you won't even be a semi-supercentenarian in 2050, since that starts at 105.  You're a mere youngster!

[SirBillybob]

17 hours ago, Vegas_Millennial said:

Join the club!

That of limitless limitations and the inevitable aggravation of unfiltered obnoxious townhall hecklers? But wait for it: your ballot will be shredded, unable to bear the weight of validation ticks coming your way. 😘

There could be XX chromosomes in the crowd. Will you be OK? Venues here and worldwide want to be sure to bend over backwards in accommodation but you’ll need to give advance notice.

Help us to help you! I possess robust antimicrobial capacity for it. 

Edited September 27, 2024 by SirBillybob

[marylander1940]

On 8/15/2024 at 8:36 AM, SirBillybob said:

An interesting read attached. So disappointed Aidsmap is done.

Dissent on doxyPEP: recent guidelines becoming more cautious | aidsmap

WWW.AIDSMAP.COM

---

Two recent statements about taking the antibiotic doxycycline up to 72 hours after sex to prevent bacterial sexually...

 

A wonderful article, thank you!

[SirBillybob]

Ongoing Doxy for bacterial STI research is sparse but, understandably, placebo control is now off the table. Results a few more years out. Without placebo arms, these are essentially superiority comparator research models though the working hypotheses are deemed non-inferiority comparison as the framing of ‘just as good, or no less ineffective’ is preferred to ‘better or less than’. Gunning for evidence of superiority also tends to introduce methodological bias.

If I refer to non-inferiority again and get whining from the rank and file about terms, I’ll merely suggest going upthread. Don’t join the seminar if you’re anaphylactic upon the call to a bit of heavy lifting. Obnoxious trolling minimally stimulates a sense of personal non-inferiority; I cannot guarantee that it’s not additionally evocative of an own troll goal. 

In Canada, comparing daily DoxyPrEP 100mg to DoxyPEP 200mg 12-24 hours post risk encounter (condomless oral or anal or both; insertive or receptive or both) but max 6 DoxyPEP doses weekly to control for the potential confounder of dosage-exceeding, aka antimicrobial overload, upon multiple encounters. Inclusion requires STI within past year. 

In Hong Kong, DoxyPEP 200mg 12-24 hrs post risk encounter, as in Canada study model above, but compared to on-demand DoxyPrEP 100mg using the same uptake structure (2-1-1-etc) as applied in on-demand HIV PrEP, in contrast to the daily DoxyPrEP (again, that version in the Canadian locations mirroring daily HIV PrEP). Qualifying behavioural STI acquisition risk past 12 months but not required to have had established an STI diagnosis within that frame.

As HIV PrEP is often an accompaniment, those without encounter journaling, multiple juggling and pillbox management skills need not apply. Phew! Did I mention I just reupped my condom and tenofovir/embitritacine supply in keeping with my operating threshold situated on the dividing line between non-negative to negative about sex? 

Edited September 28, 2024 by SirBillybob

[Luv2play]

On 9/28/2024 at 3:03 AM, SirBillybob said:

Ongoing Doxy for bacterial STI research is sparse but, understandably, placebo control is now off the table. Results a few more years out. Without placebo arms, these are essentially superiority comparator research models though the working hypotheses are deemed non-inferiority comparison as the framing of ‘just as good, or no less ineffective’ is preferred to ‘better or less than’. Gunning for evidence of superiority also tends to introduce methodological bias.

If I refer to non-inferiority again and get whining from the rank and file about terms, I’ll merely suggest going upthread. Don’t join the seminar if you’re anaphylactic upon the call to a bit of heavy lifting. Obnoxious trolling minimally stimulates a sense of personal non-inferiority; I cannot guarantee that it’s not additionally evocative of an own troll goal. 

In Canada, comparing daily DoxyPrEP 100mg to DoxyPEP 200mg 12-24 hours post risk encounter (condomless oral or anal or both; insertive or receptive or both) but max 6 DoxyPEP doses weekly to control for the potential confounder of dosage-exceeding, aka antimicrobial overload, upon multiple encounters. Inclusion requires STI within past year. 

In Hong Kong, DoxyPEP 200mg 12-24 hrs post risk encounter, as in Canada study model above, but compared to on-demand DoxyPrEP 100mg using the same uptake structure (2-1-1-etc) as applied in on-demand HIV PrEP, in contrast to the daily DoxyPrEP (again, that version in the Canadian locations mirroring daily HIV PrEP). Qualifying behavioural STI acquisition risk past 12 months but not required to have had established an STI diagnosis within that frame.

As HIV PrEP is often an accompaniment, those without encounter journaling, multiple juggling and pillbox management skills need not apply. Phew! Did I mention I just reupped my condom and tenofovir/embitritacine supply in keeping with my operating threshold situated on the dividing line between non-negative to negative about sex? 

I’ve read elsewhere in this thread that the Doxypep dosage of 200 mg should be taken 24 to 72 hours post potential exposure to an STI, not 12 to 24 hours as you stated. 
 

Also that if one has more than one sexual encounter in a weekend that the dosage of 200 mg of doxycycline should be taken Monday morning. 
 

Since that was the case for me this weekend, I will be taking my meds tomorrow morning with breakfast and avoid dairy products. 

[josh282282]

7 hours ago, Luv2play said:

I’ve read elsewhere in this thread that the Doxypep dosage of 200 mg should be taken 24 to 72 hours post potential exposure to an STI, not 12 to 24 hours as you stated. 

No. Your understanding of the timing of the dose is incorrect.  You should take DoxyPEP ASAP after sex, not wait for 24 hours. What you are describing is not consistent with the research on DoxyPEP. As time elapses away from the encounter,  effectiveness decreases.

Please note the "ideally" is not 24 hrs LATER, but "within". Per research that was published from the New England Journal of Medicine: 

https://www.nejm.org/doi/full/10.1056/NEJMoa2211934

Participants were counseled to take 200 mg of doxycycline ideally within 24 hours but no later than 72 hours after any condomless anogenital, vaginal, or oral sex and to take no more than one dose every 24 hours.

 

7 hours ago, Luv2play said:

Also that if one has more than one sexual encounter in a weekend that the dosage of 200 mg of doxycycline should be taken Monday morning. 

 

No. That is also incorrect.   If you have more than one sexual parner experience in a 24 hour period you should only take 1 two hundred milligram dose, as soon as possible after the first encounter in that 24 hour period. Dosing for a Saturday nite sex play should not wait till Monday. Also, no need for repeat doses within that 24 hour period.  In other words,  only one dose per 24 hrs. Yes, you can take daily if you are having daily sexual encounters.

I wish you, and all my brothers safe sex & travels. 

Josh 

 

[Luv2play]

2 hours ago, josh282282 said:

No. Your understanding of the timing of the dose is incorrect.  You should take DoxyPEP ASAP after sex, not wait for 24 hours. What you are describing is not consistent with the research on DoxyPEP. As time elapses away from the encounter,  effectiveness decreases.

Please note the "ideally" is not 24 hrs LATER, but "within". Per research that was published from the New England Journal of Medicine: 

https://www.nejm.org/doi/full/10.1056/NEJMoa2211934

Participants were counseled to take 200 mg of doxycycline ideally within 24 hours but no later than 72 hours after any condomless anogenital, vaginal, or oral sex and to take no more than one dose every 24 hours.

 

 

No. That is also incorrect.   If you have more than one sexual parner experience in a 24 hour period you should only take 1 two hundred milligram dose, as soon as possible after the first encounter in that 24 hour period. Dosing for a Saturday nite sex play should not wait till Monday. Also, no need for repeat doses within that 24 hour period.  In other words,  only one dose per 24 hrs. Yes, you can take daily if you are having daily sexual encounters.

I wish you, and all my brothers safe sex & travels. 

Josh 

 

The New England Journal of Medicine published in April 2023 stated the method used in the Doxypep testing was taking 200 mg within 72 hours of condomless sex. 

[SirBillybob]

On 9/30/2024 at 2:43 AM, Luv2play said:

The New England Journal of Medicine published in April 2023 stated the method used in the Doxypep testing was taking 200 mg within 72 hours of condomless sex. 

That’s from the abstract, usually limited in word count allowance, and Josh elaborated the protocol upthread. 12-24 hour post sex uptake in current research is consistent with that idea. Study subjects also get hours of structured counselling around their specific circumstances, even after having met inclusion criteria. 

A research report informs product guidance but is not the actual guidance.

Moreover, the trial published in NEJM supplied delayed-release Doxy. To elaborate illustratively the timing as referenced by Josh earlier, I doubt that it is prudent to get fucked between Saturday night hockey periods and defer the desired antimicrobial intervention, a treatment that is slow-walked into your bioavailability needs, to Tuesday half-price movie night accompanied by your butterless popcorn and skittles. It is simply an arbitrary methodological post- encounter time to prophylaxis boundary but the study protocol is not set up to seek a correlation between uptake timing and efficacy. It is reasonably inferred but impossible to substantiate that a study subject always taking the dosage at hour 71 is more vulnerable to STI acquisition compared to the fellow always taking it at hour 41, all obviously give or take according to intimacy patterns and the arbitrary 24-hour gap between doses.

The current arbitrary 12-hour lapse requested by investigators between sex and uptake is, similarly, not a contradiction to the ‘as soon as you can get those pills into you’ caveat but is established in order to knit together within the study protocol architecture the realities of access to drug as-needed post encounter and the necessity of a reasonably level and common playing field, of some degree of uniformity among research subjects in terms of exposure risk and the intervention targeting prevention of disease, particularly when various participant protocol assignment arms are compared. 

Edited October 1, 2024 by SirBillybob