DoxyPEP and Antibiotic Resistance: The Real Risk

What is antibiotic resistance?

When bacteria learn to survive

Petri dish with bacterial cultures in a laboratory

Each time bacteria meet an antibiotic, the few that happen to survive can multiply. Over time, the medicine works less well against them. That is antibiotic resistance.

It does not only concern the bacteria that cause an STI. An antibiotic also reaches the harmless bacteria on your skin, in your throat and in your gut. Those can become resistant too, and pass that on to other bacteria.

That is why health authorities, like the European ECDC, advise doxyPEP for people at high risk of STIs, and not as something everyone should take.

Per bacterium

What the research shows so far

Resistance to doxycycline and related antibiotics, per type of bacteria.

GonorrhoeaNeisseria gonorrhoeaeAlready common

More than half is resistant to tetracyclines, which is why doxyPEP only partly prevents gonorrhoea. Studies suggest doxyPEP use can push this further up.

SyphilisTreponema pallidumNot seen so far

No resistance to doxycycline has been found. This is where doxyPEP works best and where guidelines focus.

ChlamydiaChlamydia trachomatisNot seen so far

Resistance to doxycycline is not a problem in practice. DoxyPEP strongly lowers chlamydia.

Skin and gut bacteriaFor example Staphylococcus aureusWatched closely

Studies saw more tetracycline resistance in these everyday bacteria among doxyPEP users. What that means in the long run is still being researched.

What you can do

Five ways to keep the risk small

1. Only after a real risk

Take doxyPEP after sex without a condom, not "just in case" and not before sex.

2. Never more than 200 mg in 24 hours

More sex in one day? One dose covers it. Extra doses do not add protection, only more antibiotic.

3. Test every three months

Testing finds the infections doxyPEP missed, so they get the right treatment instead of more doxycycline.

4. Never use it as treatment

Symptoms or a positive test? See a doctor for the full, correct treatment. DoxyPEP tablets are not enough.

5. Let a doctor check it

Every order is checked by a doctor, who contacts you if something needs a closer look. No doctor, no doxyPEP.

Is doxyPEP still worth it?

For people with a high risk of STIs, many doctors think so. Every syphilis or chlamydia infection that doxyPEP prevents is also an infection that does not need a full course of antibiotics, and cannot be passed on. The key is using it only when there is a real risk. Read more about the benefits in how effective doxyPEP is.

What guidelines say

European and British guidelines advise doxyPEP mainly for gay and bisexual men and trans women who have had an STI before, and ask doctors to follow resistance closely. See the full overview in doxyPEP guidelines.

Frequently asked questions

Does doxyPEP cause antibiotic resistance?

It can add to it. Studies show more tetracycline resistance in gonorrhoea and in skin bacteria among people who use doxyPEP. For syphilis and chlamydia no resistance to doxycycline has been seen so far. That is why doxyPEP is meant for people with a real risk, not for everyone.

Why does doxyPEP work less well against gonorrhoea?

More than half of the gonorrhoea in Europe is already resistant to tetracyclines, the antibiotic group doxycycline belongs to. Against those strains, doxyPEP does little.

Will doxycycline still work for me later if I use doxyPEP?

For most infections, yes. Doxycycline and the antibiotics used to treat syphilis, chlamydia and gonorrhoea still work. Using doxyPEP only after a real risk keeps it that way.

How can I keep the risk of resistance small?

Only take doxyPEP after sex without a condom, never more than 200 mg in 24 hours, never as a daily habit, and keep testing every three months so infections are treated with the right medicine.

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DoxyPEP and antibiotic resistance: the real risk, and how to keep it small