2023-11-01 00:42:19
Doxycycline, when taken following sex without a condom, has been shown in clinical trials to significantly reduce the risk of infection with three diseases: chlamydia, gonorrhea and syphilis.
The main US federal health agency, the CDC (Centers for Disease Control and Prevention), is responsible for making a decision on new recommendations. It will have to take into account the need to contain epidemics affecting millions of Americans, but also the risk of increasing antibiotic resistance.
“Innovation and creativity are important in public health, and we desperately need new tools,” said CDC official Jonathan Mermin.
These recommendations, which should be published this summer, will probably only target the groups most at risk: gay men or transgender women with previous infections.
But as word spreads, some doctors are already prescribing the antibiotic for this purpose.
Malik, a 37-year-old resident of Washington who did not wish to give his last name, has already used doxycycline twice for prevention, on the advice of his doctor, following risky sex – including one with a partner not having warned that he had removed his condom.
Rising epidemics
Cases of these three bacterial infections have been increasing for a decade and reached 2.5 million in 2021 in the United States.
Firstly because mechanically, the more infections there are, the more they are transmitted.
But also because condoms are used less and less since the arrival of Prep – a medication taken as a preventative measure to avoid contracting AIDS.
Additionally, people on Prep must get tested every three months, which helps identify more infections.
Doxycycline was effective in three of four clinical trials conducted.
“We found a two-thirds reduction in sexually transmitted infections,” said Annie Luetkemeyer, who led a US trial.
The latter was carried out on 500 men who had sex with other transgender men and women.
Effectiveness was found to be higher once morest chlamydia and syphilis (-80% infections) than for gonorrhea (-55%). Side effects were few.
Antibiotic resistance
But expanding access to doxycycline has also raised concerns: antibiotic resistance might develop, particularly for gonorrhea, whose bacteria mutates rapidly.
However, initial analyzes are reassuring.
During the American clinical trial, researchers compared samples of this bacteria from infections that occurred despite treatment with doxycycline, with samples from the untreated group.
The rate of resistant bacteria was certainly higher for the treated group, but this might simply mean that the antibiotic is less effective once morest this resistant strain, not that it caused it, explained Connie Celum, co-leader of this work. .
Additionally, since doxycycline might cut the number of infections in half, that would mean half as many people needing to be treated with the antibiotic normally prescribed for gonorrhea (ceftriaxone). However, doctors want to preserve the effectiveness of this medication.
Further studies need to be carried out to understand the effect of doxycycline on other bacteria, for example in the nose or intestines.
“Additional tool”
Malik says he is happy to have been able to use doxycycline as a last resort, but wishes more men would agree to use condoms. According to him, since he moved from South Asia to the United States, fewer men are interested on dating sites and he says he does not want sex without this protection.
But according to Stephen Abbott, a doctor in Washington who prescribes and uses doxycycline, it is crucial to take into account changes in behavior. “By speaking with patients, and because I am part of the community under Prep […]I think the era of prevention via condoms is waning,” he says.
According to a head of a cultural organization in London, speaking on condition of anonymity, word of this new treatment spread quickly, and he himself now buys doxycycline on the black market.
The 42-year-old wants the United Kingdom to also adopt new recommendations, so that people are better guided, particularly on the required dosages.
For researcher Annie Luetkemeyer, doxycycline will not be the only response to the epidemic of sexually transmitted diseases. Developing a gonorrhea vaccine would still be very useful.
“But I’m optimistic,” she said. “I think it’s an additional tool.”
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