Breaking News: Doxycycline After Sex Reduces STIs (DoxyPEP)

[fskn]

Regarding DoxyPEP and fears about resistance, I defer to medical professionals. I know more than the average person, but much, much less than the researchers, clinicians and clinic leaders who are working on the DoxyPEP study, and on STI treatment in general. Ethics review boards at multiple levels are also involved.

A few points to consider:

• Doxycycline won't be handed out like candy. No responsible professional would prescribe it — off-label, at that — to a patient not at high risk of STIs. The people for whom this prevention strategy might make sense already have high STI rates.

• Resistance is complex. If you worry that using small, episodic doses of doxycycline (an older antibiotic) to prevent STIs might increase the prevalence of antibiotic-resistant bacteria, why not also worry that failing to prevent STIs might increase resistance? More infected hosts; more time between infection, diagnosis, and treatment; and presumptive (and reasonable and recommended, but nevertheless presumptive) use of a wider range of old and new antibiotics for treatment, in larger doses and/or for more days at a time; might turn out to be worse across a high-risk population like men who have sex with men (MSM).

• A great feature of the DoxyPEP study is resistance testing every time a participant gets a bacterial STI. Because there's a (legitimate) desire to treat people who have STI symptoms quickly, cheaply, and in a standardized way, resistance testing is not routine. Outside of studies, resistance testing happens after treatment failure, once it becomes necessary to try a different antibiotic. DoxyPEP participants who test positive for STIs get standard treatment, with no extra wait, but their test specimens are kept so that resistance testing can be done later, to look for patterns. If we took a less commercial, less short-term view of medical costs, we'd be doing resistance testing routinely on STI test specimens, to track resistance proactively rather than reactively.

• Whether to use doxycycline for STI PEP is a discussion between patient and medical professional. The uniquely American, consumerist practice of medicine by TV commercial (where we're told to ask for novel prescription drugs by name) is unethical, expensive, and dangerous to our health. A conversation should start with "Would this make sense for me?" rather than "Prescribe this for me, because I saw an ad for it on Lifetime/read about it on Facebook!" I certainly don't think we should shop for doctors who will say yes. Rather, when we encounter a doctor who says no, we should make sure that the decision is not borne of prejudice, outdated knowledge, or lack of experience treating GLBT patients.

Edited June 4, 2022 by fskn

[kinkatx]

I had initially purchased it simple to have some antibiotics on hand, because I go backpacking and if I have a serious injury far from civilization I want something to help control infection it Doxy was obtainable.  That vendor also sells Retinol, ED meds, bunch of interesting stuff; particular if you’ve ever dated a biochem major that was a little crazy. 😅

I happens to know I had an STI, happened just a few weeks out from a regular PrEP visit so it was a perfect opportunity to actually confirm the cheap antibiotics from India are legit instead of just trusting they’ll work when I actually need them to. 

[ErosWired]

7 hours ago, fskn said:

Regarding DoxyPEP and fears about resistance, I defer to medical professionals. I know more than the average person, but much, much less than the researchers, clinicians and clinic leaders who are working on the DoxyPEP study, and on STI treatment in general. Ethics review boards at multiple levels are also involved.

Read the bottom of the second paragraph in the notice to providers. The authors of the study make it clear that they are themselves still studying the potential for resistance as they have no data as to the risk. They are at pains to point out that Docycycline for PEP is not an FDA approved treatment, and there is no normative guidance from the CDC or any other US authority for this treatment at this time. If you defer to the professionals (by which statement we gather that you are not one), then you cannot ignore the fact that this has not been sanctioned by the medical authorities in the US. Failing to note this and advocating that members here try to persuade their caregivers to provide the treatment on their own is reckless, regardless of whether you may or may not have any specialized knowledge in the field. This is a study, and though its results appear promising, all its implications have not been addressed. Your ‘points to consider’ above are speculative, and simply highlight the need for further study.

[fskn]

1 hour ago, ErosWired said:

Failing to note this and advocating that members here try to persuade their caregivers to provide the treatment on their own is reckless

I do neither.

I have pointed out from my first message that DoxyPEP is a research study, and that a recommendation, if ever there is one, would be in the future. I have always quoted study material, with its caveats. I use terms like "off-label" (which means not FDA-approved) frankly.

In every message, I advocate discussing with a medical professional, never persuading one.

You seem to go rather far in the opposite direction, speculating — though you are clearly not a participant in the study, and don't meet regularly with researchers in this field, as I do — that STI PEP will increase resistance. Professionals aren't sure, which is why they continue to conduct research, and why they decide, in clinical practice, whether the potential benefits of an off-label prescription outweigh the potential risks.

My regular physician — licensed in California and not party to the study — has decided to provide me with doxycycline. The study researchers, the study's Data Safety and Monitoring Board, and institutional review boards (ethics watchdogs) at multiple levels have also decided to offer doxycycline to all study participants who had been randomized to the control/standard of care arm and did not originally receive it. You seem to think you know better than them, but, as I tell everyone, talk to and trust your licensed medical professional!

Edited June 4, 2022 by fskn

[Oldercumslut]

Need tomstart finding which of the online Drs do PEP.  Im do4tunate my PCP ismpretty open mimded. 

[rickyfitts]

If guys start using antibiotics regularly as prophylaxis, does anyone know what other implications this might have for things like gut health? For example, there's a lot of evidence that long term antibiotic use may contribute to obesity, cancer, cardiovascular disease, not to mention cognitive disorders like depression.

[BlkBttm4fun]

On 6/3/2022 at 2:29 AM, kinkatx said:

I’ve ordered it from All Day Chemist before  and took care of an STI myself with test to confirm. Bloodwork showed antibodies but no infection… my doctor was like “so what did you do?” 

I’ve never heard of this site and got excited to think maybe there’s something i want that I can get from them but I saw the website requires a valid prescription 

so did  you a get the prescription from a different doctor and chose to go through the website? If so, I got too exited too early! 

[Close2MyBro]

1 hour ago, rickyfitts said:

If guys start using antibiotics regularly as prophylaxis, does anyone know what other implications this might have for things like gut health? For example, there's a lot of evidence that long term antibiotic use may contribute to obesity, cancer, cardiovascular disease, not to mention cognitive disorders like depression.

These are indeed legitimate concerns. Another long-term consideration for antibiotics like Doxycycline is long-term damage to your kidneys. This is true of all of the antibiotics in the tetracycline family. Long term use is discouraged in people with chronic kidney disease. If you're on Prep that includes Truvada, you're already risking kidney disease as a side effect. I can tell you from my own personal experience that the damage starts to come on fast. I was on Truvada for about five years when I suddenly started experiencing a continued decline in kidney function. I was sent to a nephrologist and he quickly took me off of Truvada. My kidney function recovered somewhat but never returned to normal. I was put on a Prep routine that was much more kidney friendly and my kidney function has been stable, but I never fully recovered from the damage that had been done. If you're on Truvada, my advice is to watch your kidney function carefully. Once the damage is done, you seldom recover from it.

[Oldercumslut]

We aren’t talking everyday use here, just after exposure.

[BootmanLA]

5 hours ago, Oldercumslut said:

We aren’t talking everyday use here, just after exposure.

For some people on this site - me not included, no judgment involved - every day is a potential exposure for an STI. Since the point of PEP is treatment for a potential infection, rather than a diagnosed one, a person with an active sex life with strangers might well be on Doxy as PEP more often than not.

Granted, such men aren't abundant, this site's appearances notwithstanding. But it's still a potential source of antibiotic resistance. 

[ellentonboy]

On 6/30/2022 at 9:41 PM, Close2MyBro said:

These are indeed legitimate concerns. Another long-term consideration for antibiotics like Doxycycline is long-term damage to your kidneys. This is true of all of the antibiotics in the tetracycline family. Long term use is discouraged in people with chronic kidney disease. If you're on Prep that includes Truvada, you're already risking kidney disease as a side effect. I can tell you from my own personal experience that the damage starts to come on fast. I was on Truvada for about five years when I suddenly started experiencing a continued decline in kidney function. I was sent to a nephrologist and he quickly took me off of Truvada. My kidney function recovered somewhat but never returned to normal. I was put on a Prep routine that was much more kidney friendly and my kidney function has been stable, but I never fully recovered from the damage that had been done. If you're on Truvada, my advice is to watch your kidney function carefully. Once the damage is done, you seldom recover from it.

You are really scaring me here with you post regarding Truvada.  I was on it for more than five years, maybe seven.  I was changed to Descovy and Prezcobix, only after I became resistant to the Truvada combination I was taking (after I was on four meds at once).  My bf takes Truvada and I believe it now more than five years.  Thanks for posting this, because to be honest, I am not sure just how closely his kidney functions are monitored.   We switched doctors so I am sure if our current physician knows exactly how long he has been on Truvada, and our labs are only drawn twice a year.

Thanks for the warning!

[Close2MyBro]

5 minutes ago, ellentonboy said:

You are really scaring me here with you post regarding Truvada.  I was on it for more than five years, maybe seven.  I was changed to Descovy and Prezcobix, only after I became resistant to the Truvada combination I was taking (after I was on four meds at once).  My bf takes Truvada and I believe it now more than five years.  Thanks for posting this, because to be honest, I am not sure just how closely his kidney functions are monitored.   We switched doctors so I am sure if our current physician knows exactly how long he has been on Truvada, and our labs are only drawn twice a year.

Thanks for the warning!

You're welcome. I had been seeing the doctor every four months at the time, and for the first five years my kidney function was mostly stable and remained in normal ranges. Then suddenly one time my GFR dropped by about 15% and my creatinine had gone from 1.24 to 1.43. They considered anything lower than 1.30 to be normal. They sent me for blood work again another test 30 days later and it had dropped again, this time my creatinine was at 1.46. We waited again for 30 days and then tested again, now it was at 1.54. I was referred to a nephrologist and he pulled me off of every medication I was taking, including my blood pressure medication for 30 days, and had me tested again after another 30 days, and my creatinine had dropped back down to 1.38 from 1.54, still over normal but much better. He had my doctor switch me to a kidney friendly regiment and over the next few months my kidney function improved but the best it got was a creatinine level of 1.33, still above normal. Since then my creatinine has bounced around between 1.33 and 1.40. The doctor told me I had suffered some damage and its likely I'll have sensitivity to certain medications (like NSAID's) and some foods or food additives that will cause it to swing. They sent me to a nutritionist to tell me what things I should avoid that can affect the kidneys and I do my best to avoid them. We pulled my medical records before i started the Truvada and my creatinine was 0.85.

[NEDenver]

I’ve been on Truvada for 17 years, so there’s no guarantee of resistance.  I’m really good at compliance, though.  Might miss one dose a year.

[kinkatx]

On 6/30/2022 at 8:04 PM, BlkBttm4fun said:

I’ve never heard of this site and got excited to think maybe there’s something i want that I can get from them but I saw the website requires a valid prescription 

so did  you a get the prescription from a different doctor and chose to go through the website? If so, I got too exited too early! 

I’ve bought stuff from them for a decade. They’ve never asked for a script. 

[120DaysofSodom]

I think it would be better to wait to get an actual STI before taking medication than to just always be taking antibiotics because your body will build up resistance to those antibiotics and then they wont work for you in the future.