DoxyPEP (Doxycycline Post-Exposure Prophylaxis)
DoxyPEP (doxycycline post-exposure prophylaxis) is a new tool to prevent syphilis and chlamydia (though importantly, not gonorrhoea).
It involves taking 2 pills (or 200mg) of doxycycline within 72 hours after sexual activity, and has shown to reduce the chances of acquiring syphilis by 70-80% and chlamydia by 70-90%.
- Doxycycline: An antibiotic commonly used for infections.
- Post-exposure: Taken after sex.
- Prophylaxis: A scientific term for something that prevents an illness.
If you’ve had STIs in the past twelve months or have a time coming up where you have a higher chance of acquiring an STI (for example a gay cruise or a pride festival) then DoxyPEP could be suitable for you.
We encourage you to speak with your healthcare provider to discuss if DoxyPEP could be right for you. As it is relatively new, many won't know what it is, so we have a letter you can take with you to guide them to the best evidence to support discussing DoxyPEP with you.
Currently, DoxyPEP is only proven to be effective for cisgender men who have sex with men (MSM) and transgender and non-binary people assigned male at birth who are having sex with MSM. It is relatively new, and research is still emerging about the risks and benefits.
Because doxycycline is an antibiotic, the use of DoxyPEP might contribute to making some bacteria resistant to doxycycline. Most gonorrhoea in Aotearoa is already resistant to doxycycline, and this is why DoxyPEP is not likely to prevent gonorrhoea. Other bacteria in your body may also have a higher chance of becoming resistant to doxycycline. Your prescriber will discuss this potential risk with you.
Work out if you're eligible for DoxyPEP
What sex were you assigned at birth? (Whether or not you identify by that sex today)
Do you have sex with men? (Whether or not you also have sex with people of other genders)
Have you tested positive for syphilis in the last 12 months?
Have you tested positive for gonorrhoea or chlamydia more than once in the last 12 months?
Do you have a period of heightened STI transmission risk coming up? (e.g. a party or holiday that's likely to involve sex with multiple casual partners)
Do any of your sexual partners have a uterus? (This might include cisgender women or transmasculine partners)
Do you identify as Māori or a Pacific person?
Probably not right for you
DoxyPEP has only been proven in clinical trials to be effective as a preventative treatment for people assigned male at birth. But you can still keep yourself and your partners safe by testing regularly and using other prevention methods.
Probably not right for you
To minimise the potential risk of antibiotic-resistant STI strains by prescribing too widely, DoxyPEP is only recommended as a preventative treatment for people assigned male at birth who have sex with men. But you can still keep yourself and your partners safe by testing regularly and using other prevention methods.
Eligible
You're eligible for DoxyPEP! Download our letter template below to take to your GP.
Could be eligible
You could be eligible for DoxyPEP! Download our letter template below to take to your GP.
Not Eligible
Good news! Based on your answers, you do not meet the NZ Sexual Health Society's criteria for heightened risk of syphilis transmission. We would not recommend that you ask your GP about DoxyPEP, but you can still keep yourself and your partners safe by testing regularly and using other prevention methods. And remember to check back here if your sexual behaviour changes in the future to see if you might be eligible.
Find out more
How Effective is DoxyPEP?
DoxyPEP can be quite effective for cisgender men who have sex with men (MSM), and transgender and non-binary people assigned male at birth who are having sex with MSM. It can reduce your chance of acquiring syphilis by 70-80% and chlamydia by 70-90%. There are limited studies of DoxyPEP, therefore, our understanding of how effective it is may change as we learn more.
Most gonorrhoea in Aotearoa is already resistant to doxycycline. We do not expect DoxyPEP to prevent gonorrhoea and it is not recommended for this purpose.
Who can prescribe me DoxyPEP?
DoxyPEP is relatively new, and so not every prescriber may be familiar with, or happy to prescribe DoxyPEP.
However, you could speak to your local GP; we have a letter you can take to guide them to the best evidence to discuss DoxyPEP with you. Some sexual health clinics across the country have also started supplying DoxyPEP; call your local clinic to see if they are supplying DoxyPEP and to book an appointment.
If you're aged under 30 or are Māori or a Pacific person of any age, DoxyPEP should be available from your sexual health clinic at no cost.
Why is DoxyPEP only available to people assigned male at birth?
DoxyPEP has only been studied so far among cisgender men who have sex with men (MSM), and transgender and non-binary people assigned male at birth who are having sex with MSM.
One study of cisgender women taking DoxyPEP did not find it was effective but further studies are needed to understand why. There have been no other studies on people assigned female at birth, and this is why it is not currently recommended for these people.
Given the limited evidence, DoxyPEP is only for people assigned male at birth having sex with men so far. We continue to look for new evidence as it emerges to keep this recommendation as up to date as possible.
Do I have other options to prevent STIs?
Condoms are a really effective option to prevent syphilis, chlamydia and gonorrhoea. You can order some here.
If you aren’t using condoms, you may be at risk of HIV depending on your sexual activity; find out more about PrEP for HIV here.
Does DoxyPEP have any side effects?
Doxycycline has two main side effects.
Firstly, taking doxycycline can make you more sensitive to the sun. It is important to be sun-smart when using DoxyPEP as you may burn more easily.
Secondly, it is important you take DoxyPEP with water, and remain upright for half an hour after you take a dose. This is because doxycycline can damage your throat if not swallowed properly, and needs to be digested in your stomach to avoid this.
DoxyPEP also interacts with antacids (like Mylanta or Gaviscon), as well as supplements with calcium, iron, and magnesium. So if you take these supplements take them 2 hours before or after your DoxyPEP to make sure it works.
Where can I find out more about DoxyPEP?
NZ Consensus Statement:
https://www.nzshs.org/site_files/38652/upload_files/AoNZfinaldoxyPEPstatement(1).pdf?dl=1
ASHM Consensus Statement
https://ashm.org.au/about/news/doxy-pep-statement/
CDC Guidelines:
https://www.cdc.gov/mmwr/volumes/73/rr/rr7302a1.htm?s_cid=rr7302a1_w
Does DoxyPEP work if I am living with HIV?
Studies so far suggest that DoxyPEP does work for cisgender men who have sex with men and are living with HIV. It may be slightly less effective at preventing STIs but we need more research to understand this difference. If you are living with HIV, you can use DoxyPEP.
If I’m on DoxyPEP, do I still need to test for STIs?
Yes! Definitely. It is important if you test for STIs as DoxyPEP is not 100% effective. Regular testing every three months is still recommended.