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Representation depicting a chlamydia-infected mobile. Chlamydia trachomatis micro organism (represented by way of small darkish round shapes colorized blue) go through construction inside of a membrane-enclosed “inclusion body.” The darkish inexperienced form at the proper of the mobile denotes the nucleus. Credit score: NIAID
As well being care products and services start providing doxycycline to forestall bacterial sexually transmitted infections (STIs), real-world proof demonstrates that the postexposure approach, referred to as doxy PEP, is lowering the velocity of syphilis and chlamydia, however has had little to no impact on gonorrhea and wishes shut tracking for indicators of antibiotic resistance.
JAMA Inner Medication has revealed two studies of early result of doxy PEP rollout in California. Encouraging indicators and ultimate medical questions from the ones studies are highlighted in an accompanying remark by way of Jeanne Marrazzo, M.D., M.P.H., director of the Nationwide Institutes of Well being’s Nationwide Institute of Hypersensitivity and Infectious Sicknesses (NIAID), and Jodie Dionne, M.D., M.P.H., affiliate professor of medication within the Department of Infectious Sicknesses and affiliate professor of obstetrics and gynecology within the Department of Maternal-Fetal Medication on the College of Alabama at Birmingham.
“These reports are part of the crucial scientific process of translating clinical research to implementation at scale,” stated Dr. Marrazzo. “Doxy PEP is proving to be an important intervention in our effort to decrease STI incidence while we continue to invest in research to develop safe and effective preventive vaccines and next-generation antibiotics.”
The Facilities for Illness Keep an eye on and Prevention (CDC) reported greater than 2.4 million circumstances of syphilis, gonorrhea, and chlamydia in the US in 2023, together with 3,882 circumstances of congenital syphilis, of which 279 led to stillbirths and toddler deaths. Whilst the most recent information display indicators the STI epidemic could be slowing, case counts are nonetheless 90% upper than 2004 ranges and provide a risk to peoples’ well being.
Taking oral doxycycline inside of 72 hours of condomless intercourse decreased the occurrence of the bacterial STIs syphilis, chlamydia and gonorrhea by way of two-thirds amongst homosexual, bisexual, and different males who’ve intercourse with males and transgender girls in a up to date randomized managed trial. Alternatively, the antibiotic had no preventive impact in a identical find out about in cisgender girls. In line with this proof, the CDC recommends that U.S. well being care suppliers talk about doxy PEP with males who’ve intercourse with males and transgender girls who’ve a historical past of a minimum of one bacterial STI.
In one of the most new revealed analyses, public well being surveillance information from decided on public clinics in San Francisco confirmed that circumstances of early syphilis and chlamydia in males who’ve intercourse with males and transgender girls reduced by way of 50% and 51%, respectively, after 13 months of centered doxy PEP implementation, however gonorrhea occurrence larger by way of 26% in the similar period of time.
Within the different research, pharmacy prescription information from an built-in well being machine in California confirmed that when 365 days of doxy PEP rollout in other people assigned male intercourse at start who have been additionally taking HIV pre-exposure prophylaxis, STI positivity charges declined by way of 79%, 80%, and 12% for chlamydia, syphilis, and gonorrhea, respectively. The declines in gonorrhea have been restricted to infections on the urethra and rectum. No declines have been noticed on the pharynx (throat), a not unusual web page the place other people gain gonorrhea.
Of their remark, Drs. Marrazzo and Dionne celebrated doxy PEP’s considerable impact on chlamydia and syphilis in regimen well being provider settings. They cautioned that the combined effects on gonorrhea, together with effects from some other fresh find out about appearing other people taking doxy PEP had some proof of resistance to a category of antibiotics for gonorrhea remedy, level to the want to carefully observe the advance of antimicrobial resistance within the context of doxy PEP use and to incorporate measures of drug resistance in all doxy PEP research. Additionally they famous some disparities in doxy PEP uptake and the want to be certain that equitable wisdom, acceptability, and get entry to because the rollout continues.
Reflecting on ongoing analysis wishes, Drs. Marrazzo and Dionne pointed to the power gaps in doxy PEP proof for cisgender girls. They referred to as for analysis to higher perceive the connection between doxycycline dosing frequency and its preventive efficacy in real-world settings, in addition to the sturdiness of doxy PEP’s protecting results.
In any case, they highlighted broader STI intervention wishes, together with protected and efficient vaccines and new antibiotics for all other people suffering from STIs.
Additional information:
Madeline Sankaran et al, Doxycycline Postexposure Prophylaxis and Sexually Transmitted An infection Developments, JAMA Inner Medication (2025). DOI: 10.1001/jamainternmed.2024.7178
Remark: Jeanne M. Marrazzo et al, DoxyPEP to Save you Bacterial STIs—Able for High Time?, JAMA Inner Medication (2025). DOI: 10.1001/jamainternmed.2024.7165
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NIH/Nationwide Institute of Hypersensitivity and Infectious Sicknesses
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As prevention approach for sexually transmitted infections rolls out, specialists spotlight each promise and data gaps (2025, January 7)
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Publish date : 2025-01-07 08:20:15
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