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  • Technical Bulletin
  • STI

CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024

Summary

On June 6th, 2024, the U.S. Centers for Disease Control and Prevention (CDC) released clinical guidelines for the use of doxycycline post-exposure prophylaxis (doxy PEP) to prevent bacterial sexually transmitted infections (STIs) such as syphilis, chlamydia, and gonorrhea.

Doxy PEP has a demonstrated benefit in reducing incident syphilis, chlamydia, and gonorrhea in certain populations and represents a new approach to addressing STI prevention in men who have sex with men (MSM) and transgender women (TGW). Data cited in the guidelines shows that for high-risk populations there was a reduction in syphilis and chlamydia infections by >70% and gonococcal infections by approximately 50% when using doxy PEP.

Ongoing studies are being conducted to evaluate doxy PEP and PrEP, including the risk for the development of antimicrobial resistance. Currently, the available evidence in the context of increased national incidence of syphilis, chlamydia, and gonorrhea supports consideration of this approach for MSM and TGW at substantial risk for acquiring bacterial STIs. As such, the CDC recommends the following:

  1. Provide comprehensive preventative sexual health counseling and services to all sexually active individuals as indicated. This may include risk reduction counseling, screening for human immunodeficiency virus (HIV) and STIs, doxy PEP, HIV pre-exposure prophylaxis (PrEP), HIV post- exposure prophylaxis (PEP), vaccinations (e.g. Hepatitis A/B, Human Papilloma Virus, Mpox, Meningococcal/MenACWY), expedited partner therapy, contraception, linkage to care, and/or other interventions.
  2. Providers are encouraged to discuss the benefits and potential harms of using doxy PEP with all gay, bisexual, and other MSM and TGW with a history of at least one bacterial STI (syphilis, chlamydia, gonorrhea) in the last 12 months.
  3. Providers may also use a shared decision-making approach to discuss doxy PEP with MSM and TGW who have not had a bacterial STI diagnosed during the previous year but who will participate in sexual activities that are known to increase the likelihood of exposure to STIs.
  4. If offering doxy PEP, healthcare providers should write a prescription for self-administration of the recommended dose of 200 mg of doxycycline (any formulation) to be taken as soon as possible within 72 hours after having oral, vaginal, or anal sex with a maximum dose of 200mg every 24 hours. The prescription should account for enough doses on the basis of the person’s anticipated sexual activity until their next visit. Ongoing need for doxy PEP should be assessed every 3–6 months.

Treatment, Testing and Counseling Recommendations

For more Information

Additional information on doxy PEP and STI follow-up testing can be found online at:

These guidelines will be updated as additional data become available.

Questions

For updated guidance, review the Division of Public and Behavioral Health Technical Bulletin web page regularly. Email stateepi@health.nv.gov for other questions regarding Bicillin® L-A Shortage and syphilis treatment.