Bacterial sexually transmitted infections (STIs) — specifically chlamydia, gonorrhea, and syphilis — remain a significant public health challenge in the United States. Several factors contribute, including a combination of high rates of asymptomatic infection, rising antimicrobial resistance, social stigma, and systemic healthcare barriers.
DoxyPEP (doxycycline post-exposure prophylaxis), an antibiotic used after sexual intercourse to help prevent bacterial STIs, is an emerging prevention strategy to lower the number of new cases. Current evidence suggests DoxyPEP can significantly reduce the risk of bacterial STIs among certain patient populations.
DoxyPEP’s potential to reduce STI disparities depends on patient awareness, trust, and willingness to use it.
A new study examined how racial and ethnic minority patients may perceive DoxyPEP and what may influence their willingness to use it.
DoxyPEP is doxycycline taken shortly after sexual exposure to help prevent bacterial STIs. Research shows that taking 200 milligrams (mg) of doxycycline within three days (or 72 hours) after sexual intercourse can help some patients reduce the chances of getting syphilis, chlamydia, and, in some studies, gonorrhea.
The Centers for Disease Control and Prevention (CDC) has clinical guidelines on the use of DoxyPEP for the following patient populations:
Patients prescribed DoxyPEP should receive routine STI and HIV screening every three to six months, and the drug should be complemented with regular screenings, HIV PrEP, and relevant vaccinations.
DoxyPEP is a patient-managed intervention taken after sexual exposure, so correct self-administration is essential to safe and effective use. For clinicians, patient understanding and acceptance of DoxyPEP matter alongside education and support. Awareness, trust, and access to healthcare can influence uptake across communities, with implications for clinical success, individual safety, and broader public health outcomes.
Researchers recruited patients at Howard Brown Health and University of Chicago Medical Center through study recruitment flyers and phone calls to patients identified as eligible using electronic medical record (EMR) data.
Of the 50 patients screened, 26 were eligible and enrolled. Participants were predominantly Black and Latino sexual and gender minority adults receiving care at urban health centers in Chicago. Each participant completed a 60-minute, one-on-one interview with a staff member through an audio-only videoconference call.
After the interview, the participants completed surveys on demographics, attitudes towards DoxyPEP, and medical and personal history.
Across the study, researchers explored the following topics:
The researchers aimed to identify factors that could affect equitable adoption of the STI prevention strategy.
Participants’ interviews and surveys described how they viewed DoxyPEP as an STI prevention option. Their responses highlighted factors that may influence willingness to use it.
Here were the key findings:
These findings reflect the perspectives of the 26 participants recruited for the study. They offer insight into patient experiences, but don’t establish how common these views are among racial and ethnic minority patients more broadly. Willingness to use DoxyPEP also shouldn’t be treated as evidence of actual uptake.
Some participants shared how a provider’s recommendations made them more open to taking DoxyPEP.
“I actually learned the information from my peers. And then, of course, once I heard about it, I did bring it to the attention of my healthcare provider, and he pretty much confirmed what it was that I heard, gave me a little more information on what I didn’t know, and put me on the prescription.”
Culturally responsive communication may be critical when introducing newer prevention strategies like DoxyPEP, as some patients – particularly those from underserved communities – may be hesitant to try it.
Shared decision-making is especially important when discussing eligibility for DoxyPEP, as it often depends on individual sexual health history, risk factors, and patient preferences. Clinicians should be prepared to answer questions about safety, effectiveness, antibiotic resistance, and appropriate use.
Building trust with a patient may help address misconceptions and improve informed uptake of DoxyPEP.
DoxyPEP represents a promising addition to STI prevention efforts. Clinicians may need to proactively discuss DoxyPEP with patients who could benefit based on CDC clinical guidelines. When discussing treatment, tailor education to the patient’s cultural, community, and health literacy needs. Clinicians should also recognize patient concerns early on to improve implementation and adherence.
The findings underscore the importance of engaging communities that have historically experienced barriers to preventive healthcare and sexual health education.
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