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Abstract
Objectives This systematic review aimed to identify the efficacy, adherence, safety and impact on antimicrobial resistance of postexposure prophylaxis with doxycycline (Doxy-PEP) in different populations.
Methods We searched MEDLINE (via PubMed), Embase and Cochrane CENTRAL databases from inception to 29 May 2024. Two reviewers independently screened the studies and extracted data. We included randomised clinical trials that evaluated the efficacy of Doxy-PEP within 72 hours after condomless sex. A random-effects meta-analysis was conducted to compare the risk of bacterial sexually transmitted infections (STIs) between Doxy-PEP and no prophylaxis. The risk of bias was assessed with the risk-of-bias tool for randomized trials (RoB 2) and the certainty of evidence (CoE) with Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results Four studies were included in the systematic review, totalling 1727 participants. Studies were conducted between 2015 and 2022. Most participants (73%) were men who have sex with men, and the median age of participants varied from 24 to 43 years. Doxy-PEP reduced the risk of having any bacterial STI in different populations by 46% (hazard ratio (HR) 0.54; 95% CI 0.39 to 0.75; CoE moderate), the risk of chlamydia by 65% (relative risk (RR) 0.35; 95% CI 0.15 to 0.82; CoE low) and syphilis by 77% (RR 0.23; 95% CI 0.13 to 0.41; CoE high), without significant effect for risk of gonorrhoea infection (RR 0.90; 95% CI 0.64 to 1.26; CoE very low). The self-reported adherence rate of Doxy-PEP was approximately 80% and one drug-related serious adverse event was reported.
Conclusion Doxy-PEP reduced the incidence of chlamydia and syphilis infections. No significant reduction in gonorrhoea infection was observed. This strategy seems promising for some high-risk groups; however, there is still a lack of information on the induction of bacterial resistance and long-term adverse events.
- Post-Exposure Prophylaxis
- Chlamydia Infections
- Gonorrhea
- NEISSERIA GONORRHOEAE
- SYPHILIS
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Footnotes
Handling editor Eric PF Chow
Contributors PRS is the guarantor of this study and is responsible for the project ideation, study design, data extraction, data analysis, interpretation of results and manuscript writing. CBM provided methodological guidance and conducted data extraction, data analysis, interpretation of results and manuscript writing. SD, AVS and UT acquired data, conducted research on the topic and wrote the manuscript. KS wrote and corrected the manuscript. We used the website Grammarly to check some grammar mistakes in some text passages. The authors wrote all the text.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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