Doxycycline post-exposure prophylaxis for preventing bacterial sexually transmitted infections (STIs): Are clinical providers supportive?

Abstract

Background: Bacterial sexually transmitted infections (STIs) continue to increase in the United States. Despite evidence of the effectiveness of doxycycline post-exposure prophylaxis (Doxy-PEP) to prevent STIs, little is known about providers' attitudes and willingness to implement Doxy-PEP.

Methods: An online questionnaire was sent to 575 clinical providers in New York State in September 2022.

Results: Ninety-one eligible individuals responded. Most providers served men who have sex with men (MSM) (84%); reported willingness to recommend Doxy-PEP (98%, 77%, and 67% for chlamydia, syphilis, and gonorrhea, respectively); preferred Doxy-PEP administration for MSM and transgender populations; believed recurring bacterial STIs (88%) and reported condomless sex (85%) were the most important characteristics to consider for recommending Doxy-PEP; and were concerned about antibiotic resistance (90%) (primarily for Neisseria gonorrhoeae). Insurance costs were the most perceived community-associated barriers (35%). There were no significant differences in providers' recommendations towards Doxy-PEP use when comparing clinicians' years of experience, regions, or professional titles.

Conclusions: Study results suggest high willingness and support for implementing Doxy-PEP. As this survey was administered prior to national guidelines on the use of Doxy-PEP, these data can be used as a baseline to compare to studies conducted after their release to formulate appropriate messages for providers to improve implementation.

Keywords: Doxycycline prophylaxis; bacterial STIs; post-exposure prophylaxis.

Figure 1.

Most survey respondents would recommend Doxy-PEP to prevent bacterial STIs (N = 89). Only 5 of the 89 respondents (5.6%) would not recommend Doxy-PEP to prevent bacterial STIs, even if it is approved by the CDC.

Figure 2.

Percent of respondents that would recommend Doxy-PEP for the prevention of each STI, if approved by the CDC. Respondents would be most willing to recommend Doxy-PEP for the prevention of chlamydia, followed by syphilis and gonorrhea (N = 84).

Figure 3.

Concern of respondents towards the potential drug resistance of Neisseria gonorrhoeae (gonorrhea), Treponema pallidum (syphilis), chlamydia trachomatis (chlamydia) (N =66). Degree of concern was rated on a scale of 0 to 3, with 0 being not concerned at all and 3 being most concerned. Respondents were most concerned about drug resistance of N gonorrhoeae.