Filling in the Gaps: Updates on Doxycycline Prophylaxis for Bacterial Sexually Transmitted Infections

Over the past 2 decades, cases of sexually transmitted infections (STIs) from syphilis, gonorrhea, and chlamydia have been rising in the United States, disproportionately among gay, bisexual, and other men who have sex with men, as well as racial and ethnic minorities of all genders. In this review, we address updates about the evidence on doxycycline postexposure prophylaxis for prevention of bacterial STIs, including efficacy, safety, antimicrobial resistance, acceptability, modeling population impact, and evolving guidelines for use. Equitable implementation of doxycycline postexposure prophylaxis will require evaluation of who is offered and initiates it, understanding patterns of use and longer term STI incidence and antimicrobial resistance, provider training, and tailored community education. Sexually transmitted infections are surging in the United States in several key populations. This review explores the effectiveness, safety, acceptability, impact on antimicrobial resistance, and evolving clinical guidelines of doxycycline postexposure prophylaxis in preventing bacterial sexually transmitted infections.