Why do they differ?
The benefit of doxyPEP is clear for syphilis and chlamydia. The worry is antibiotic resistance, especially in gonorrhoea, which in Europe is already often resistant to tetracyclines. European authorities therefore prefer targeted use where the benefit is largest. Read more in doxyPEP and antibiotic resistance.
Guidelines and women
Most guidelines do not yet advise doxyPEP as standard for cisgender women, because the only large study in women did not show a clear effect. The UK guideline lets doctors decide case by case. See doxyPEP for women.
Frequently asked questions
Is doxyPEP officially recommended?
In the United States (CDC, 2024) and the United Kingdom (BASHH, 2025) there are official guidelines that recommend doxyPEP for gay and bisexual men and trans women at higher risk. The European ECDC (2026) advises it on an individual basis for people at high risk, not for everyone.
What dose do all guidelines use?
All of them use the same dose: 200 mg doxycycline once, ideally within 24 hours and no later than 72 hours after sex without a condom, and no more than 200 mg in 24 hours.
Is doxyPEP recommended for women?
Not yet as a standard. The one large study in women did not show a clear effect. The UK guideline allows doctors to consider it for women at high risk of syphilis, case by case.
Why is Europe more cautious than the US?
Mainly because of antibiotic resistance. Gonorrhoea in Europe is already very often resistant to tetracyclines, and experts want to avoid more resistance by using doxyPEP only where the benefit is largest.
