2023-07-17 08:30:03
Antiretroviral drugs against HIV are displayed on a stand in Abidjan, as part of the ICASA conference (International Conference on AIDS and STIs in Africa).
©SIA KAMBOU / AFP
Public health
A new prevention strategy, with the taking of an antibiotic (doxycycline), could contribute to the fight against the resurgence of sexually transmitted diseases.
Atlantico: A new prevention strategy could contribute to the fight against the resurgence of sexually transmitted diseases. Could you explain to us what it really consists of?
Stéphane Korsia-Meffre: This strategy consists of a single dose, within 72 hours after sexual intercourse, of a common antibiotic, doxycycline, in order to reduce the risk of gonorrhea, syphilis or chlamydia. This antibiotic has been used for decades. This preventive intake is associated with vaccination against meningitis (whose germ is close to that of gonorrhea) to improve the effectiveness of this preventive treatment.
The idea of preventive antibiotic treatment against STIs was born in the 1970s, before the emergence of AIDS, mainly within American gay communities. At the time, some people used to visit a doctor on Friday for an antibiotic injection, to protect themselves over the weekend. What is new here is the intake immediately after sexual intercourse and the synergistic association with vaccination against meningitis.
What do we learn from the studies done so far about the benefits, risks and limitations of this treatment?
We know that doxycycline after sex reduces the risk of gonorrhea by about 50%, and by more than 80% the risk of syphilis or chlamydia. Vaccination against meningococci further improves this efficacy against gonorrhea (with approximately 30% additional risk reduction). At present, this treatment remains mainly interesting for people with intense sexual activity or sex workers.
Although there are no recommendations from the Haute Autorité de santé on this subject yet, many sexual health centers have already started to prescribe this treatment. It is obvious that it must be accompanied by patient awareness and, as for PrEP (prevention of HIV/AIDS), a bacteriological assessment must be carried out every three months in search of STIs. Obviously, this new strategy must be part of other sexual health measures: vaccination against hepatitis and monkey pox, PrEP, HIV testing, etc. There is never a silver bullet when it comes to sexual health.
Regarding adverse effects and effectiveness, is there a difference between taking before exposure and taking after exposure?
Studies concerning pre-exposure intake have not been carried out. Obviously, the meningitis vaccine must be administered at least 15 days before intercourse to be effective. Its duration of effectiveness is at least 2 years. Until now, healthcare professionals favor taking doxycycline after exposure, in order to avoid potentially unnecessary intake in the absence of sexual intercourse.
The only risks are the appearance of resistant strains. There are already some for gonorrhea vis-à-vis doxycycline (which, as a result, is never treated with this antibiotic), but they should not appear for syphilis or chlamydia (the latter is often treated with doxycycline). We are awaiting data from studies to determine whether this preventive treatment increases the risk of the appearance of germs resistant to doxycycline, but the preliminary data are reassuring.
Due to the single dose, the relatively minor adverse effects of doxycycline are rarely observed in this context.
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