Abstract
OBJECTIVE:
The CDC recommends doxycycline post-exposure prophylaxis (doxyPEP) for men who have sex with men (MSM) with a bacterial sexually transmitted infection (bSTI) in the past year. This study explored determinants of doxyPEP awareness and uptake, and associations with HIV care outcomes, among U.S. MSM living with HIV.
DESIGN:
Cross-sectional study.
METHODS:
From 10/2023–10/2024, we enrolled 827 MSM living with HIV from 46 states, Washington, D.C., and Puerto Rico via a popular geospatial networking app. Adjusted multivariable logistic regression examined determinants of doxyPEP awareness/use and associations with HIV treatment adherence, viral suppression, and care engagement.
RESULTS:
Among 827 participants, 13% were currently taking doxyPEP, 46% were aware of doxyPEP but not prescribed it, and 41% had not heard of it. Of 360 participants CDC-eligible for doxyPEP, 20% were prescribed it, 49% had heard of it but were not on it, and 31% were unaware, 95% of whom expressed interest. Neither awareness nor use of doxyPEP was associated with HIV care outcomes. Both awareness and uptake of doxyPEP were higher among participants with a recent bSTI (adjusted odds ratio (aOR)=1.15, 95%CI: 1.06–1.25; aOR=1.11, 95%CI: 1.05–1.17, respectively) and lower in the U.S. Midwest, Mountain, and South regions (inverse-variance weighted average (IVW-Avg) aOR=0.81, 95%CI: 0.76–0.86; IVW-Avg aOR=0.86, 95%CI: 0.82–0.90, respectively) relative to Pacific states.
CONCLUSIONS:
High doxyPEP interest underscores unmet demand in integrated HIV/sexual health care. Sociodemographic and geographic disparities in doxyPEP implementation necessitate targeted interventions for MSM living with HIV to optimize impact on the bSTI epidemic.
Keywords: doxyPEP, bacterial sexually transmitted infections, urine point of care test, HIV infection, antiretroviral therapy
INTRODUCTION
The incidence of bacterial sexually transmitted infections (bSTIs) in the U.S. remains high despite national efforts to reduce syphilis, gonorrhea, and chlamydia infections by 2025 [1,2]. Recent research has explored doxycycline as a potential biomedical intervention to reduce bSTIs. Studies published in 2015 and 2018 demonstrated that doxycycline, taken daily or shortly after sex, significantly reduced bSTI incidence among men who have sex with men (MSM) [3,4]. Larger studies have since evaluated on-demand use of doxycycline as post-exposure prophylaxis (doxyPEP), administered within 72 hours after sex, and shown reductions in syphilis, chlamydia, and to a lesser extent, gonorrhea [5,6].
In June 2024, the U.S. Centers for Disease Control and Prevention (CDC) endorsed doxyPEP for MSM with a bSTI in the past year [7]. Like early uptake of HIV PrEP [8], doxyPEP implementation preceded formal national recommendations [9–11]. Prior research has demonstrated substantial interest in doxyPEP, though significant sociodemographic disparities exist in its adoption within single-clinic settings [12–16]. Additionally, preliminary data show high awareness, readiness, and motivation to provide doxyPEP among health care practitioners with experience providing HIV PrEP and sexual health care to MSM [17,18]. As doxyPEP is scaled up in the U.S., studies are needed to assess awareness, uptake, and real-world use to promote equitable access [13,19–21].
Limited data exist on doxyPEP adoption among U.S. MSM living with HIV. Furthermore, sociodemographic and geographic factors influencing doxyPEP awareness, interest, and uptake remain inadequately characterized across U.S. regions. The primary aims of this study were to explore the association between doxyPEP exposure and HIV care continuum outcomes and characterize early implementation among U.S. MSM living with HIV.
METHODS
Study Population
From 10/2023–10/2024, we recruited 1,000 cisgender MSM living with HIV through a staged enrollment approach via a popular geosocial networking/dating app for a remote national prospective cohort study called ARCHES, designed to primarily measure substance use, antiretroviral therapy (ART) adherence, and viral suppression (VS) (NIH/NIDA UG3DA058304). The 827 enrolled respondents who completed supplemental doxyPEP-related survey questions at baseline were included in this cross-sectional analysis (Supplemental Materials). The University of California, San Francisco Committee on Human Research approved this study, and all participants provided informed consent virtually via the secure REDCap platform.
Outcome measures
The primary outcome was doxyPEP awareness and use and its association with HIV care continuum outcomes among U.S. MSM living with HIV, assessed at enrollment to ARCHES: 1) ART adherence, measured objectively with validated point-of-care urine tenofovir tests, mailed to participants to evaluate short-term adherence (categorized as detectable vs. undetectable [22]); 2) VS (determined by plasma viral load testing at local Quest laboratory sites (categorized as suppressed (<200copies/ml) vs. unsuppressed); and 3) engagement in care (based on self-reported attendance at an HIV appointment in the past six months).
The secondary objective was to examine sociodemographic, geographic, and sexual health-related factors associated with doxyPEP awareness, CDC guideline-based eligibility [7], interest after learning about it, and uptake among U.S. MSM living with HIV. These factors were assessed through self-developed, remote surveys (Supplemental Materials).
Statistical Analysis
DoxyPEP awareness and uptake, HIV care outcomes, and sociodemographic characteristics associated with exposure to doxyPEP were explored using multivariable logistic regression, with each model adjusted for age, race/ethnicity, income, region, and bSTI history. Findings are presented as adjusted odds ratios (aORs) or inverse-variance weighted average (IVW-Avg) aORs for composite indices, with 95% confidence intervals (95%CI) and a significance threshold of p<0.05.
Additional Study Covariates
To examine associations between doxyPEP exposure and HIV care outcomes, and evaluate for sociodemographic, geographic, and sexual health-related characteristics influencing doxyPEP awareness and use, we included key covariates in our adjusted models: age, race/ethnicity, income, region, and bSTI history. These covariates were selected based on the published literature on HIV/bSTI treatment and prevention, as well as substantive concerns related to healthcare access in the U.S [2,12–16,20]. By controlling for these covariates, we aimed to better isolate associations between HIV care outcomes and doxyPEP exposure.
RESULTS
Participant Characteristics
Among 827 participants (median age: 40 years; range: 21–74)), 47% identified as White, 40% as Black, 21% as Hispanic/Latino, 3% as Asian/Pacific Islander, and 10% as Multiracial (3.1%) or Other (6.8%). Nearly half (47%) reported an annual income <$25,000, while 53% earned ≥$25,000, including 12% with incomes exceeding $75,000 (Table 1). Respondents represented 46 U.S. states, Washington, D.C., and Puerto Rico (Figure 1).
Table 1.
Characteristics of Study Participants
| Characteristic | Overall (N=827) | On doxyPEP (n=109) | Aware of but not on doxyPEP (n=383) | Unaware of doxyPEP (n=335) |
|---|---|---|---|---|
| Age, median (range) – years | 40.4 (21.0, 73.8) | 39.1 (22.8, 65.0) | 38.6 (21.0, 73.8) | 42.9 (22.2, 72.7) |
| Ethnicity – no. (%) | ||||
| Hispanic/Latino | 171 (20.7%) | 20 (18.3%) | 85 (22.2%) | 66 (19.7%) |
| Non-Hispanic/Latino | 656 (79.3%) | 89 (81.7%) | 298 (77.8%) | 269 (80.3%) |
| Race – no. (%) | ||||
| Asian/Pacific Islander | 25 (3.0%) | 6 (5.5%) | 12 (3.1%) | 7 (2.1%) |
| Black | 329 (39.8%) | 49 (44.9%) | 150 (39.1%) | 130 (38.8%) |
| Multiracial/Other | 82 (9.9%) | 9 (8.3%) | 39 (10.2%) | 32 (9.6%) |
| White | 391 (47.3%) | 43 (39.4%) | 182 (47.5%) | 166 (49.6%) |
| Annual income – no. (%) | ||||
| $0 - $24,999 | 390 (47.2%) | 44 (40.4%) | 170 (44.4%) | 176 (52.5%) |
| $25,000 - $74,999 | 335 (40.5%) | 45 (41.3%) | 164 (42.8%) | 126 (37.6%) |
| $75,000 - $150,000 or greater | 102 (12.3%) | 20 (18.3%) | 49 (12.8%) | 33 (9.9%) |
| Region – no. (%) | ||||
| Midwest | 144 (17.4%) | 10 (9.2%) | 66 (17.2%) | 68 (20.3%) |
| Mountain | 60 (7.3%) | 4 (3.7%) | 28 (7.3%) | 28 (8.4%) |
| Northeast | 191 (23.1%) | 30 (27.5%) | 85 (22.2%) | 76 (22.7%) |
| Pacific | 158 (19.1%) | 36 (33.0%) | 75 (19.6%) | 47 (14.0%) |
| South | 274 (33.1%) | 29 (26.6%) | 129 (33.7%) | 116 (34.6%) |
| STI history – no. (%) | ||||
| STI in the past 12 mos | 360 (43.5%) | 73 (67.0%) | 175 (45.7%) | 112 (33.4%) |
| No STI in the past 12 mos | 467 (56.5%) | 36 (33.0%) | 208 (54.3%) | 223 (66.6%) |
| ART adherence – no. (%) | ||||
| Urine TFV detected | 472 (57.1%) | 62 (56.9%) | 216 (56.4%) | 194 (57.9%) |
| Suboptimal urine TFV detected | 87 (10.5%) | 5 (4.6%) | 43 (11.2%) | 39 (11.6%) |
| Missing/ Not on TFV-regimen | 268 (32.4% | 42 (38.5%) | 124 (32.4%) | 102 (30.4%) |
| HIV viral suppression – no. (%) | ||||
| Suppressed <200 copies/ml | 706 (85.4%) | 99 (90.8%) | 331 (86.4%) | 276 (82.4%) |
| Not suppressed >200 copies/ml | 121 (14.6%) | 10 (9.2%) | 52 (13.6%) | 59 (17.6%) |
| HIV care engagement – no. (%) | ||||
| Recent HIV appointment | 756 (91.4%) | 106 (97.2%) | 350 (91.4%) | 300 (89.6%) |
| No recent HIV appointment | 71 (8.6%) | 3 (2.8%) | 33 (8.6%) | 35 (10.4%) |
Figure 1.
DoxyPEP Awareness and Uptake among U.S. MSM Living with HIV
44% of participants reported a past-year bSTI. Of those on a tenofovir-containing ART regimen who submitted point-of-care urine tests, 84% (472/559) had detectable urine tenofovir. Additionally, 85% of participants achieved VS (HIV viral load <200 copies/ml), and 91% attended a recent HIV appointment (Table 1).
DoxyPEP and HIV care continuum outcomes
Neither doxyPEP awareness (IVW-Avg aOR=1.04, 95%CI: 0.97–1.13) nor doxyPEP uptake (IVW-Avg aOR=1.05, 95%CI: 0.99–1.11) was significantly associated with HIV care outcomes in adjusted models (Supplemental Table).
DoxyPEP awareness
Overall, 59% (n=492) of participants were aware of doxyPEP, while 46% (n=383) had heard of it but were not on it, and 41% (n=335) were unaware of it (Table 1). DoxyPEP awareness was greater among individuals with a past-year bSTI (aOR=1.15, 95%CI: 1.06–1.25, p<0.001) compared to those without, and among those with annual incomes ≥$25,000 ($25,000–$74,999: aOR=1.12, 95%CI: 1.02–1.22, p=0.013; ≥$75,000: aOR=1.26, 95%CI: 1.10–1.44, p<0.001) compared to those who earned less. There was lower doxyPEP awareness among participants in all other regions relative to the Pacific (IVW-Avg aOR=0.82, 95%CI: 0.78–0.87; South: aOR=0.80, 95%CI: 0.71–0.90, p<0.001; Northeast: aOR=0.87, 95%CI: 0.76–0.99, p=0.033; Midwest: aOR=0.82, 95%CI: 0.71–0.94, p=0.004; Mountain: aOR=0.81, 95%CI: 0.69–0.97, p=0.018) (Supplemental Table).
Among participants unaware of doxyPEP (n=335), 89% expressed interest in starting it after learning about it. Of those aware of doxyPEP but not on it (n=383), 84% reported willingness to start it if offered it at their HIV clinic. Among 360 individuals meeting CDC eligibility criteria for doxyPEP, 69% had heard of it, 49% were aware but not on it, and 31% were unaware of it, 95% of whom expressed interest after learning about its indication and use. Of CDC-eligible participants aware of but not on doxyPEP, 93% would start it if offered by their HIV provider.
DoxyPEP uptake
Only 13% (n=109) of all participants were prescribed and taking doxyPEP (Table 1), including 20% of those meeting CDC eligibility criteria. Greater doxyPEP uptake was observed among those reporting a bSTI in the past year (aOR=1.11, 95%CI: 1.05–1.17, p<0.001). Lower doxyPEP uptake was noted in the South (aOR=0.85, 95%CI: 0.79–0.93, p<0.001), Midwest (aOR=0.87, 95%CI: 0.80–0.96, p=0.003), and Mountain regions (aOR=0.88, 95%CI: 0.79–0.99, p=0.032) compared to the Pacific (IVW-Avg aOR=0.86, 95%CI: 0.82–0.90) (Supplemental Table).
Overall, 84% (598/715) of those not prescribed or taking doxyPEP (regardless of having heard about it or not) indicated they would start it if offered it at their HIV clinic.
DoxyPEP users’ perceptions and behaviors
Of those prescribed doxyPEP (n=109), 14% had been on it for ≥12 months, 24% for six months, 25% for three months, 17% for one month, and 21% for less than one month. In the four weeks before survey completion, 22% of participants prescribed doxyPEP had not taken it at all, while 38% reported taking it monthly, 18% used it weekly, 12% took it several days per week, and 10% used it nearly daily. Most participants (91%) received their prescription from the same provider managing their ART, while 2% were prescribed doxyPEP by another provider at the same clinic, and 7% obtained it from a different provider at another location, typically in primary or urgent care settings.
DISCUSSION
To our knowledge, this is the first description of early doxyPEP adoption among a U.S. national sample of MSM living with HIV. This study highlights the potential and challenges of doxyPEP implementation and reveals underutilization in certain groups and regions. Despite moderate awareness (59%) and low uptake (13%), high interest among those not currently on doxyPEP (>80%) suggests substantial opportunities for expanding access. This study shows that bSTI history was associated with both knowledge and uptake of doxyPEP, suggesting that doxyPEP was reaching individuals likely to have future bSTIs [23]. While most participants received doxyPEP from HIV care providers, some accessed it through separate clinics, pointing to potential barriers to consolidated care. Although neither awareness nor use of doxyPEP was associated with improved HIV care outcomes, participants expressed great interest in co-located HIV/bSTI services, emphasizing the benefits of integrated care models.
No disparities in doxyPEP exposure were found based on race/ethnicity, which may reflect successful efforts to proactively respond to interest among key groups most impacted by bSTIs, specifically Black and Hispanic/Latino MSM [24].
However, as previously described in the literature [13,16,20], we found striking socioeconomic disparities in doxyPEP awareness, with participants earning <$25,000 annually less likely to know of doxyPEP, suggesting the need to further prioritize equitable implementation. Lower awareness and uptake regionally, most notably in the South, mirror regional bSTI epidemic and HIV care disparities [2]. In addition to initial doxyPEP demonstration and implementation projects in California [25] and Washington influencing higher awareness and uptake in the Pacific region, public health campaigns promoting its use may be unevenly distributed. States with fewer resources or less focus on bSTI prevention may face challenges in prioritizing awareness. Structural barriers, such as state-specific Medicaid policies, limited access to specialized sexual health services, fewer public sexual health campaigns, and lower levels of LGBTQ policy equality may contribute to regional disparities [21]. Continued research on doxyPEP’s use should ensure its rollout targets groups most impacted by bSTIs, address regional and sociodemographic disparities while leveraging high community interest, and optimize equitable access through integrated care.
Our study had limitations. Despite objective measurement of ART adherence and VS, reliance on self-report for doxyPEP exposure, HIV care engagement, and bSTI history is subject to poor recall and social desirability bias. A cross-sectional design, while useful for estimating prevalence and generating hypotheses, limits evaluation of causal inference between doxyPEP exposure and HIV outcomes. Future research should monitor doxyPEP use (via objective metrics) and evaluate real-world effectiveness and uptake of doxycycline as pre-exposure prophylaxis (doxyPrEP) [26–28], with longitudinal studies needed to assess doxyPEP as sustained bSTI prevention and its impact in HIV care. Finally, monitoring for antimicrobial resistance is essential to ensure doxyPEP’s long-term safety and effectiveness.
Our findings underscore the importance of expanding doxyPEP implementation through strategic integration into routine HIV and primary care services. Clinics should prioritize patient education, emphasizing the benefits and appropriate use of doxyPEP, to enhance adherence and effectiveness. Targeted efforts are needed in regions where knowledge and uptake of doxyPEP remain low. With high interest in doxyPEP, increasing provider awareness and simplifying prescribing pathways will help facilitate broader adoption. Along with doxyPEP’s impact on antimicrobial resistance, future research should ensure equitable implementation and identify barriers to its adoption to avoid perpetuating existing inequities in the national bSTI epidemic.
Supplementary Material
Acknowledgements.
The authors acknowledge the assistance of all our site research directors, coordinators, assistants, and participants without whom this study would not have been possible.
Funding sources:
NIH/NIMH K23MH122286 and NIH/NIDA UG3DA058304 (MAS); NIH/NIAID R01AI143340 (MG).
Data availability.
Deidentified data are available upon request from the principal investigator of the study (MAS; matthew.spinelli@ucsf.edu); the request will need to be reviewed and approved by the study’s leadership team.
REFERENCES
- 1.U.S. Department of Health and Human Services (HHS). (2020). Sexually Transmitted Infections National Strategic Plan for the United States: 2021–2025. Washington, DC. Retrieved from https://www.hhs.gov. [Google Scholar]
- 2.Centers for Disease Control and Prevention (CDC). (2024). Sexually Transmitted Disease Surveillance, 2023. U.S. Department of Health and Human Services. November 12, 2024. Available from https://www.cdc.gov/sti-statistics/annual/index.html [Google Scholar]
- 3.Bolan RK, Beymer MR, Weiss RE, Flynn RP, Leibowitz AA, Klausner JD. Doxycycline prophylaxis to reduce incident syphilis among HIV-infected men who have sex with men who continue to engage in high-risk sex: a randomized, controlled pilot study. Sex Transm Dis. 2015;42(2):98–103 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Molina JM, Charreau I, Chidiac C, et al. Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial. Lancet Infect Dis. 2018;18(3):308–317. doi: 10.1016/S1473-3099(17)30725-9 [DOI] [PubMed] [Google Scholar]
- 5.Luetkemeyer AF, Donnell D, Dombrowski JC, et al. Postexposure doxycycline to prevent bacterial sexually transmitted infections. N Engl J Med. 2023;388(14):1296–1306. doi: 10.1056/NEJMoa2211934 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Molina JM, Bercot B, Assoumou L, et al. Doxycycline prophylaxis and meningococcal group B vaccine to prevent bacterial sexually transmitted infections in France (ANRS 174 DOXYVAC): a multicentre, open-label, randomised trial with a 2 × 2 factorial design, The Lancet Infectious Diseases, Volume 24, Issue 10, 2024, Pages 1093–1104, ISSN 1473–3099, 10.1016/S1473-3099(24)00236-6. [DOI] [PubMed] [Google Scholar]
- 7.Bachmann LH, Barbee LA, Chan P, et al. CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024. MMWR Recomm Rep 2024;73(No. RR-2):1–8. DOI: 10.15585/mmwr.rr7302a1 Recommendations and Reports / June 6, 2024 / 73(2);1–8 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Krakower DS, Beekmann SE, Polgreen PM, Mayer KH. Diffusion of New HIV Prevention Innovations: Variable Practices of Frontline Infectious Diseases Physicians. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2016;62(1):99–105. doi: 10.1093/cid/civ736. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.San Francisco Department of Public Health. Health update: Doxycycline post-exposure prophylaxis reduces incidence of sexually transmitted infections. October 20, 2022. Available from https://www.sf.gov/sites/default/files/2024-04/Health-Update-Doxycycline-Post-Exposure-Prophylaxis-Reduces-Incidence-of-Sexually-Transmitted-Infections-SFDPH-FINAL-10.20.2022.cleaned.pdf
- 10.Public Health-Seattle & King County. Doxycycline post-exposure prophylaxis (doxy-PEP) to prevent bacterial STIs in men who have sex with men (MSM) and transgender persons who have sex with men. June 9, 2023. Available from: https://kingcounty.gov/en/-/media/depts/health/communicable-diseases/documents/hivstd/DoxyPEP-Guidelines.ashx
- 11.California Department of Public Health. Dear colleague letter—doxycycline postexposure prophylaxis for the prevention of bacterial sexually transmitted infections. April 28, 2023. Available at: https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CDPH-Doxy-PEP-Recommendations-for-Prevention-of-STIs.pdf
- 12.Bacon O Implementation of a doxy-PEP program at a municipal STI clinic in San Francisco. Abstract presented at: STI & HIV 2023 World Congress; July 1, 2023; Chicago, IL. [Google Scholar]
- 13.Ogunbajo A, Henry C, Barney A, Anderson T, Brown J, Hickson D. Predictors of receiving a doxycycline postexposure prophylaxis (Doxy-PEP) prescription for the prevention of bacterial sexually transmitted infections (STIs) in a community-based clinic: a case-control study. Sex Transm Infect. 2024. Sep 10:sextrans-2024–056291. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Sankaran M, Glidden DV, Kohn RP, et al. Doxycycline Postexposure Prophylaxis and Sexually Transmitted Infection Trends. JAMA Intern Med. Published online January 06, 2025. doi: 10.1001/jamainternmed.2024.7178 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Chan PA, Malyuta Y, Parent H, Tao J, Erbe M, Salhaney P, Maynard M, DeWitt W, Reisopoulos A, Nunn A. Early adopters of doxycycline as post-exposure prophylaxis to prevent bacterial sexually transmitted infections in a real-world clinical setting. Sex Transm Infect. 2024. Aug 19;100(6):339–342. doi: 10.1136/sextrans-2024-056152. [DOI] [PubMed] [Google Scholar]
- 16.Mayer KH, Traeger M, Gitin Sy, Kraft J, Khan T. Early Adopters: Implementation of Doxycycline Postexposure Prophylaxis in a Boston Health Center. Abstracts presented at: Conference on Retroviruses and Opportunistic Infections; March, 2024; Denver, CO. [Google Scholar]
- 17.Phillips C, Vineusa M, Fowler C, et al. Doxycycline postexposure prophylaxis (doxyPEP): sexual health clinicians’ knowledge and readiness. Sexually Transmitted Infections Published Online First: 29 October 2024. doi: 10.1136/sextrans-2024-056388 [DOI] [PubMed] [Google Scholar]
- 18.Perkins R, Beima-Sofie K, Christopoulos K, Cohen SE, et al. “Another tool for the sexual health toolkit”: U.S. health care provider knowledge and attitudes about doxycycline post-exposure prophylaxis (doxy-PEP) to prevent bacterial sexually transmitted infections among men who have sex with men. Sex Transm Dis. 2024. October 31. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Cannon CA, Celum CL. Doxycycline postexposure prophylaxis for prevention of sexually transmitted infections. Top Antivir Med. 2023. Dec 5;31(5):566–575. [PMC free article] [PubMed] [Google Scholar]
- 20.Traeger MW, Krakower DS, Mayer KH, Jenness SM, Marcus JL. Use of doxycycline and other antibiotics as bacterial sexually transmitted infection prophylaxis in a U.S. sample of primarily gay and bisexual men. Sex Transm Dis. 2024. Aug 8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Samuel KD, Ellis MS, Buttram ME. The impact of socio-environmental factors on doxycycline post-exposure prophylaxis awareness in the US: a cross-sectional study. Sex Health. 2024. May;21:SH23176. [DOI] [PubMed] [Google Scholar]
- 22.Gandhi M, Bacchetti P, Spinelli MA, Okochi H, Baeten JM, Siriprakaisil O, Klinbuayaem V, Rodrigues WC, Wang G, Vincent M, Cressey TR, Drain PK. Brief Report: Validation of a Urine Tenofovir Immunoassay for Adherence Monitoring to PrEP and ART and Establishing the Cutoff for a Point-of-Care Test. J Acquir Immune Defic Syndr. 2019;81(1):72–77. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Traeger MW, Mayer KH, Krakower DS, Gitin S, Jenness SM, Marcus JL. Potential impact of doxycycline post-exposure prophylaxis prescribing strategies on incidence of bacterial sexually transmitted infections. Clin Infect Dis. 2023. Aug 18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Spinelli MA, Scott HM, Vittinghoff E, Liu AY, Coleman K, Buchbinder SP. High interest in doxycycline for sexually transmitted infection postexposure prophylaxis in a multicity survey of men who have sex with men using a social networking application. Sex Transm Dis. 2019; 46(4):e32–e34. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Traeger MW, Leyden WA, Volk JE, Silverberg MJ, Horberg MA, Davis TL, Mayer KH, Krakower DS, Young JG, Jenness SM, Marcus JL. Doxycycline Postexposure Prophylaxis and Bacterial Sexually Transmitted Infections Among Individuals Using HIV Preexposure Prophylaxis. JAMA Intern Med. 2025. Jan 6. doi: 10.1001/jamainternmed.2024.7186. Epub ahead of print. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Mohammed S, Hull M, Burchell AN, et al. Doxycycline as an intervention for bacterial sexually transmitted infection Chemoprophylaxis (DISCO) study: design of a national, multicentre randomized-controlled trial. In: 31st Annual Canadian Conference on HIV/AIDS Research. Virtual, 2022. [Google Scholar]
- 27.Haire (Australia; 2019-present), IH U.S. National Library of Medicine ClinicalTrials.gov. Impact of the Daily Doxycycline Pre-exposure Prophylaxis (PrEP) on the Incidence of Syphilis, Gonorrhoea and Chlamydia (Syphilaxis) [NCT03709459], 2018. Available at: https://classic.clinicaltrials.gov/ct2/show/NCT03709459.
- 28.Abe S, Shiojiri D, Kawashima A, et al. Doxycycline PrEP prevents STIs without affecting vaginal bacterial flora in female sex workers in Tokyo. Presented at: 25th International AIDS Conference (AIDS 2024); July 22–26, 2024; Munich, Germany. [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
Deidentified data are available upon request from the principal investigator of the study (MAS; matthew.spinelli@ucsf.edu); the request will need to be reviewed and approved by the study’s leadership team.