Studies have found that doxycycline postexposure prophylaxis (Doxy-PEP), when administered within 72 hours of condomless sex, reduces the incidence of syphilis, chlamydia and gonorrhoea among sexual minority men (SMM).1–3 The Centers for Disease Control and Prevention (CDC) recently released clinical guidelines on the administration of Doxy-PEP for sexually transmitted infection (STI) prevention.4 The current study investigated the association between sociodemographic characteristics, sexual risk-taking behaviours, recent STI diagnosis, HIV pre-exposure prophylaxis (PrEP) use and receiving a Doxy-PEP prescription for STI prevention among a sample of racial and sexual minority individuals receiving healthcare services at a community clinic in Washington, DC. We focused on racial and sexual minority populations as these groups are primarily served by the community clinic. We analysed the electronic medical records of clients (n=100) who received services at Us Helping Us, People Into Living, Inc, between May and November 2023. Cases were defined as clients who were prescribed Doxy-PEP and controls were defined as clients who were not prescribed Doxy-PEP. Clients were eligible for Doxy-PEP if they had any reactive STI results in the previous 6 months; the CDC guidelines recommend counselling for sexual minority men (SMM) and transgender women with an incident STI in the previous year. Matched controls were selected using a 3:1 control to case ratio (matching on clinical visit date (within 2 weeks), age (±3 years) and HIV status). We abstracted sociodemographic characteristics, self-reported sexual risk behaviours, knowledge of HIV PrEP, substance use, STI test results and current HIV PrEP use. Unadjusted and adjusted conditional matched pair logistic regression was performed to investigate factors associated with Doxy-PEP use. The adjusted model included variables that were significant at the p<0.1 level in the unadjusted model. Data were analysed using SPSS 29 (IBM, 2024). Participants’ (n=100) sociodemographic characteristics are provided in Table 1. The 26 individuals who were prescribed Doxy-PEP were matched to 74 unique controls. Individuals who were prescribed Doxy-PEP were more likely to report: anal sex with a cisgender male in the previous 12 months (86% vs 62%; p=0.05), higher number of receptive anal sex acts in the previous 6 months (1.88 vs 1.02; p=0.06), having a history of condomless sex with a cisgender male (80% vs 58%; p=0.08), having a reactive gonorrhoea test result (17% vs 2%; p=0.005) and current PrEP use (65% vs 30%; p=0.003). In the multivariable logistic regression model, all predictor variables that were significant (p<0.1) at the bivariate level became statistically insignificant. However, current daily PrEP use was marginally associated with being prescribed Doxy-PEP (OR 0.80; 95% CI 0.67 to 1.02). To our knowledge, this is the first study to explore the predictors of Doxy-PEP utilization among this subpopulation in a real-world setting, thus contributing to the growing body of scientific research on real-world utility of Doxy-PEP for the prevention of bacterial STIs. Our findings suggest that individuals who might have elevated risk for incident STIs are more likely to be prescribed Doxy-PEP. Consequently, interventions to increase awareness of and access to Doxy-PEP, especially among racial and sexual minority communities, are urgently needed. We found that condomless sex, a major driving force of STI transmission, and a recent STI diagnosis were associated with receiving a Doxy-PEP prescription. This finding is in line with previous studies that have found sexual risk taking and STI acquisition to be associated with utilisation of STI prophylaxis.4–7 Given the release of the CDC clinical guidelines, we propose that health programs and interventions : (1) increase Doxy-PEP awareness and knowledge among potential clients and healthcare providers to increase Doxy-PEP uptake, (2) incorporate Doxy-PEP into a comprehensive sexual health approach that includes regular STI screenings, risk reduction counselling, discussions of pleasure and individual approaches to maximising sexual pleasure while minimising risk for STI infections, and (3) explore the viability of pharmacies and other avenues as dissemination points for sexual health services such as Doxy-PEP and PrEP. We found that current PrEP users were more likely to have received a Doxy-PEP prescription. These findings are in line with previous studies that have demonstrated a significant association between a history of PrEP use and Doxy-PEP use.4 5 It is important that clinical interactions with healthcare providers about Doxy-PEP and PrEP are framed in a sexually affirming and non-judgemental manner rather than a stigmatising and shameful one, as this has been demonstrated to dissuade and discourage uptake of these medications by populations who can greatly benefit from these biomedical interventions.8–10 Lastly, it is imperative that Doxy-PEP is made available at little to no cost to individuals who qualify based on the CDC guidelines as costs remain a major barrier to accessing these prevention measures.

Bivariate predictors of receiving a Doxy-PEP prescription (n=100)

Not applicable.

An initial submission to our ethics board (Pearl IRB) determined that no ethics approval was required due to the utilisation of information collected during routine medical visit.

Factors associated with reported sti prophylaxis (“doxy-prep/doxy-pep”) use among hiv-prep users in the uk. : HIV MEDICINE. WILEY 111 RIVER ST, HOBOKEN 07030-5774, NJ USA, .