Counsel all transgender women and MSM w hx of 1 bacterial STI syphilis chlamydia or gonorrhea in the past 12mo about the benefits and harms of doxycycline PEP 3

By rray, 18 June, 2024
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Recommended dose 200 mg doxycycline any formulation x1 ASAP w in 72h of oral vaginal or anal sex max 200 mg q24h
May darr gonococcal infxns by 50
Implement doxy PEP as part of a comprehensive sexual approach including risk reduction counseling STI screening and tx including HIV screening for HIV negative pts recommended vaccination and linkage to HIV PrEP HIV care or other services as appropriate
Perform bacterial STI testing at anatomic sites of exposure at baseline and q3 6mo thereafter
Assess ongoing need for doxy PEP q3 6mo
Adverse effects most assoc w doxy include photosensitivity and GI sx including esophageal erosion and ulceration Most ADRs resolve w medication d c
Evidence is insufficient in assessing the benefits and harms of doxy PEP in cisgender women cisgender heterosexual men transgender men and other queer and nonbinary persons
Although not directly assessed in trials doxy PEP could be discussed w transgender women and MSM who haven t been diagnosed w a bacterial STI in the past yr but will engage in sexual activities that uarr likelihood of STI exposure
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Counsel all transgender women and MSM w/ hx of ≥1 bacterial STI (syphilis, chlamydia, or gonorrhea) in the past 12mo about the benefits and harms of doxycycline PEP.<sup>3</sup>