Doxycycline: What Is It Good For? Absolutely Not PrEP.

A report back on Vincent Cornelisse’s presentation ‘Attitudes Towards and Use of Antibiotic Prophylaxis for Sexually Transmitted Infections in Australia; An Online Survey’ 

The charismatic Vincent Cornelisse delivered the results of a large online survey regarding the use of doxycycline as pre and post exposure prophylaxis for STI’s by men who have sex with men (MSM). The use of doxycycline is not recommended or indicated for such a purpose in any Australian guideline, and the evidence for its use overseas is questionable at best. Despite this, a whopping 13% of MSM participating in the study responded that they had used doxycycline as STI prophylaxis, which equates to hundreds of men. Perhaps what is even more disturbing is that 50% of these men reported getting the doxycycline prescribed by their GP (and the rest possibly ordering it online). 

It is unclear whether GPs are willingly prescribing the doxycycline for STI prophylaxis or whether patients are lying to their doctors by claiming the medication is for other purposes, such as their skin. Regardless of how they are obtaining the doxycycline, doctors and the wider sexual health community should be vigilant and take steps to discourage doxycycline use amongst the MSM community until we get more evidence of its safety and efficacy as STI prophylaxis. As doxycycline does not have antimicrobial activity against every STI, its use as PEP or PrEP could lead to increases in condomless anal sex and dangerous sexual practices, leading to increased transmission of STIs. 


Author bio: 

Christopher Marr is a clinical pharmacist with a Bachelor of Pharmacy from Curtin University, a Graduate Diploma in Clinical Pharmacy from the University of Tasmania, and a background in both hospital and community pharmacy in Perth. Currently he works closely with General Practitioners in a non-dispensing role at View Street Medical as a consultant pharmacist. The practice specialises in sexual health and delivers an optimised and collaborative healthcare service to our patients through our dedicated multidisciplinary team. 

  • What dose of Doxycycline is being discussed? 50 mg daily, 100 mg daily or 109 mg BD?

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    This Lancet article is a well placed rebuttal of the above.

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