Health care providers should consider prescribing the antibiotic doxycycline as a way to prevent some sexually transmitted infections (STIs), according to a draft recommendation that was posted by the U.S. Centers for Disease Control and Prevention (CDC) last week.
“The purpose of the proposed guidelines is to provide updated clinical guidance for healthcare providers to inform the use of doxycycline PEP for preventing bacterial STI infections,” the health agency's document reads, referring primarily to bacterial infections such as chlamydia, gonorrhea, and syphilis.
The antibiotic "should be implemented in the context of a comprehensive sexual health approach including risk reduction counseling, STI screening and treatment, recommended vaccination, and linkage to HIV pre-exposure prophylaxis (PrEP), HIV care, or other services, as appropriate," according to the draft.
“Current data suggest overall benefit of the use of doxycycline PEP, but potential risks related to the development of resistance and impacts on the microbiome will need to be closely monitored after implementation of these guidelines,” the CDC stated.
Doxycycline, which was first developed by Pfizer decades ago and is within the tetracycline spectrum of antibiotics, has been used as a prophylactic against several infectious diseases, including Lyme disease and malaria. It can be used as a first-line treatment for chlamydia and is sometimes used to treat syphilis.
The public has about 45 days to comment on the proposed rule via the Federal Register's website.
Dr. Jonathan Mermin, a CDC official who heads the agency's division on STIs, told CNN that the health agency would seek public comment because it allows researchers and policymakers "to gather important input before finalizing guidance and gives clinical providers, people affected by STIs, and partner organizations the opportunity to weigh in before ... guidance is finalized.”
"It's going to take game-changing innovations for us to turn the STI epidemic around. And Doxy-PEP is the first major new prevention intervention we have for STIs in decades," Dr. Mermin told CBS News last week, noting that his agency will have to also monitor for
There are gaps in the "long-term monitoring, evaluation, and additional studies" regarding the use of doxycycline, according to the CDC official.
"There are important questions that remain regarding potential risks," he said.
Although health officials say the drug is generally tolerated well, doxycycline can have a range of side effects, including diarrhea or vomiting, rash or itching, changes to the appearance of nails, irritation of the esophagus, loss of taste, and tinnitus. Notably, it can darken the color of one's skin, teeth, gums, or scars, according to health officials.
Some have reported that lying down after taking the antibiotic can cause the medication to reflux back into the esophagus, causing irritation or even ulcers.
STIs Skyrocketing
STIs have been on the rise across the United States in recent years, according to the CDC. More than 2.5 million cases of chlamydia, gonorrhea, and syphilis were reported in all of 2021, the CDC stated, noting that syphilis rates increased by 32 percent, chlamydia by 4 percent, and gonorrhea by more than 4 percent from 2020 to 2021.
The CDC's report states that communities such as "gay and bisexual men and younger people" have been "hit especially hard" by STIs in recent years.
Months ago, San Francisco's health department started promoting doxycycline as a prevention measure, according to a report from the Associated Press.
“We didn’t feel like we could wait,” said Dr. Stephanie Cohen, who oversees the local agency's STI prevention work.
Some other city, county, and state health departments, mostly on the West Coast, have since followed suit.
Earlier this year, local health authorities in Houston issued a warning that syphilis infections are on the rise. The recent increase was attributed to pregnant women, who can pass the bacteria to their unborn babies, the Houston Health Department said in a June statement.
“It is crucial for pregnant women to seek prenatal care and syphilis testing to protect themselves from an infection that could result in the deaths of their babies,” Marlene McNeese Ward, an assistant director with the Houston health agency, said in the statement at the time. “A pregnant woman needs to get tested for syphilis three times during her pregnancy.”
The Associated Press contributed to this report.
