Sexually transmitted infections (STIs) have been increasing at an alarming rate in the U.S. Data from the Centers for Disease Control (CDC) shows that cases of syphilis in particular have climbed dramatically, along with gonorrhea.
Experts in This Article
certified nurse practitioner and director of clinical operations, TBD Health
emergency physician and medical director of Wisp
To combat these increases, doxycycline, an antibiotic marketed as DoxyPEP, is now being prescribed as a “morning-after pill” of sorts that you can use to prevent bacterial STIs after having unprotected sex. But don’t throw out your condoms just yet. Read on to find out who this pill can help, and how it works.
What is DoxyPEP (doxycycline)?
Doxycycline has been around the block a few times, and has proven itself effective. It’s been used as an antibiotic and disease preventative since the 1960s, and is powerful enough to prevent life-threatening diseases like malaria and anthrax.
Healthcare providers already use DoxyPEP to treat chlamydia, and sometimes syphilis and gonorrhea. A study published in the New England Journal of Medicine earlier this year showed that it also reduces transmission of bacterial infections—like syphilis, gonorrhea, and chlamydia—when used prophylactically (meaning, for prevention purposes before symptoms arise). The CDC now plans to release guidelines for prophylactic use later this summer.
In order to be effective when used this way, you need to take two 200mg DoxyPEP tablets within 72 hours after having condomless sex. Experts say the sooner, the better. You don’t need to know your partner’s infection status to use it. You also don’t need to wait until you’ve had condomless sex to get a prescription.
Fortunately, since it’s an older drug, it’s relatively inexpensive and readily available. Even without insurance, DoxyPEP should run you around $22.
The caveats: DoxyPEP is by no means a 100-percent guarantee that you won’t contract your partner’s STI—though it can greatly diminish your risk. And like all antibiotics, DoxyPEP is ineffective against viral diseases, like HIV and monkeypox. It also won’t prevent pregnancy, and isn’t a cure for STIs.
Who Is DoxyPEP recommended for?
In its current iteration as DoxyPEP, doxycycline is being primarily prescribed for men who have sex with men and transwomen who have sex with men. However, no one, including ciswomen, is exempt from acquiring a prescription.
As of now, we only have evidence (from the 2023 study) that doxycycline can be successfully repurposed to prevent bacterial infections in men who have sex with men and in transwomen who have sex with men. Some of this study’s participants were living with an HIV infection; others were taking preventative medications against HIV. Every participant had already been diagnosed with an STI within the past year. Doxycycline produced an overall 65 percent reduction in new STI infections in these populations.
Studies have also been done on cisgender women, primarily in Kenya. These studies have produced less promising results, but the reasons why are not clear.
“For people with vaginas, we don’t have enough evidence to confirm that this medication is effective for preventing STIs. The best studies showing the efficacy of this treatment have looked at DoxyPEP in people who were born with penises,” says certified nurse practitioner Adrienne Ton, APRN-CNP, of TBD Health, a sex-positive healthcare company. Ton would like to see more research on DoxyPEP for cisgender women who have receptive vaginal sex, but for now, she doesn’t currently recommend it to her cisgender women patients.
How to safely use DoxyPEP
DoxyPEP is meant for one-time or occasional use after you’ve had condomless sex—not as a daily or near-daily preventative. Even though doxycycline is fairly well-studied, its use as an STI preventive is still very new. It’s not known yet how much is too much, so experts don’t recommend using it too often, or instead of condoms.
“DoxyPEP is only one tool among a whole strategy of approaches for promoting sexual health and preventing disease, a strategy which might include things like regular STI testing, HIV PrEP, contraception, and condoms/dental dams,” says Ton. If you routinely get tested for STIs, don’t stop testing because you’ve used DoxyPEP.
Many medical professionals—including Ton—are concerned that overuse of DoxyPEP may increase the risk of antibiotic resistance and vulnerability to “superbugs.” (Certain strains of gonorrhea are already antibiotic-resistant.)
Side effects are also possible. The most common ones are headache, stomachache, and nausea. And doxycycline is in the tetracycline class of antibiotics, which may make you more sensitive to sunburns than you usually are.
It’s also worth noting that dairy products and calcium supplements may reduce DoxyPep’s effectiveness. You’ll want to go over the other prescriptions and supplements you currently take with your doctor.
Where to get DoxyPEP
Many doctors are already prescribing DoxyPEP for their high-risk patients, and some insurance companies are covering the medication.
If you prefer, you can also get a prescription for DoxyPEP through Wisp, a sexual-health-focused telehealth company, which offers home delivery or pickup at your local pharmacy.
“Anyone of any gender or sex can receive a prescription for DoxyPEP through Wisp,” says Suneer Chander, MD, Wisp’s medical director. “Doxycycline is considered low-risk, which is why Wisp is confident in prescribing DoxyPEP to all of our patients,” he adds.
Anything that makes sex safer and more joyful is a very good thing. It’s worth celebrating that DoxyPEP can offer one more tool to help you enjoy your love life without compromising your health.
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