Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Miscellaneous Letter
90 (
5
); 671-672
doi:
10.25259/IJDVL_1078_2023
pmid:
38841971

Pre and post-exposure prophylaxis with doxycycline: Exploring promises for prevention of sexually transmitted infections in the Indian context

Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Corresponding author: Dr. Anuradha Bishnoi, Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. dranha14@gmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Mehta H, Gupta M, Bishnoi A, Vinay K. Pre and post-exposure prophylaxis with doxycycline: Exploring promises for prevention of sexually transmitted infections in the Indian context. Indian J Dermatol Venereol Leprol. 2024;90:671-2. doi: 10.25259/IJDVL_1078_2023

Dear Editor,

Sexually transmitted infections (STIs) pose a significant global public health challenge, with over 1 million newly acquired cases daily worldwide. In India, despite limited centralised data, an estimated 6% of adults contract STIs annually and syphilis emerges as the predominant STI among men in the clinical data of STIs, with a prevalence ranging from 12.6% to 57%, followed by chlamydia (20%–30%), chancroid (9.9%–34.7%) and gonorrhoea (8.5%–25.9%).1 Recent studies also underscore concerning trends, including high vaginal discharge rates, low condom usage, increasing gonococcal infection-related urethritis, and rising syphilis prevalence.2 Rising use of geosocial networking apps among the Indian population again has implications for HIV/STI transmission.

Despite the availability of antibiotics for the treatment of symptomatic bacterial STIs, the high prevalence of asymptomatic infections poses great challenges to combat the spread of HIV and other STIs. Asymptomatic STI is particularly worrisome when present among those with a high potential to cause dissemination, especially in the presence of limited sexual health literacy and barriers to healthcare access. Traditional contact tracing methods face limitations in identifying anonymous partners and are also bound by resource constraints, stigma, and socio-cultural factors.

STI prevention has traditionally focused on early detection and adequate treatment. Pre-exposure prophylaxis (PrEP) for populations at higher HIV risk is an important and established strategy in STI prevention. Notably, doxycycline, an affordable, broad-spectrum tetracycline antibiotic, has emerged as a promising option for bacterial STI prevention, both as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). The Centers for Disease Control and Prevention (CDC) has recommended a 7-day doxycycline course for chlamydia prevention since 2014. Recent research expanded its role as PEP, with a single 200-mg dose taken within 24 hours after unprotected sex substantially reducing the risk of bacterial STIs.3 Among men who have sex with men (MSM) and transgender women, PEP with doxycycline reduced combined gonorrhoea, chlamydia, and syphilis cases by two-thirds compared to standard care.4

In a pilot clinical trial, daily 100 mg doxycycline as PrEP significantly reduced bacterial STIs in MSM living with HIV over 48 weeks, outperforming other incentives for staying STI-free.5 Ongoing trials, the daily doxycycline in HIV and for syphilis PrEP (DaDHS) and the dual daily HIV and syphilis pre-exposure prophylaxis (DuDHS) aim to evaluate the efficacy of doxycycline in preventing syphilis and other STIs among MSM.6 Recognising the mounting burden of bacterial STIs, various global health authorities recommend PEP with doxycycline, especially for high-risk groups like MSM, transgender women, and commercial sex workers (CSWs) with previous bacterial STIs.7

Current Indian National AIDS Control Organisation (NACO) guidelines 2021 for STI PEP in sexual assault victims recommend azithromycin and cefixime for chlamydia and gonorrhoea, along with metronidazole or tinidazole for trichomoniasis and bacterial vaginosis. For hepatitis B virus (HBV) exposure, they suggest hepatitis B immunoglobulin, and for HIV prevention, a triple-drug antiretroviral regimen. In light of recent evidence, Indian guidelines may contemplate including self-administered doxycycline as an option for PEP, especially in high-risk groups. This approach aligns with India’s diverse population facing barriers to consistent condom use and healthcare access. PEP with doxycycline particularly serves as a valuable tool for individuals who may not have control over barrier contraceptives, such as CSWs and others at high risk for STIs. The ready availability, affordability, and tolerability of doxycycline make it a safe STI prevention choice, though caution is advised for pregnant or individuals trying to conceive. Single-dose doxycycline PEP offers flexibility for those with irregular sexual activity, mitigating STI stigma in India with a discreet and accessible prevention method.

Yet, there are concerns regarding potential over-reliance on PEP with doxycycline, possibly diminishing the emphasis on condom use and regular STI testing. Daily dosing requirements can be challenging, especially for those with frequent sexual activity. Additionally, the ideal duration of PEP with doxycycline remains uncertain, raising questions about prolonged use and associated risks like antibiotic resistance and subclinical infections. The chronic, intermittent use of antibiotics, such as doxycycline, also raises concerns about impacting the normal microbiome and favouring multidrug-resistant bacteria, such as gonococci and methicillin-resistant Staphylococcus aureus. While PEP with doxycycline shows promise, its successful implementation must carefully consider these complexities and drawbacks within the broader framework of a comprehensive STI prevention approach.

In conclusion, PEP and PrEP with doxycycline emerge as promising strategies to mitigate the substantial burden of bacterial STIs in India; however, they face a series of distinctive challenges. Crucially, addressing low sexual health literacy is necessary, as misconceptions about of the purpose and scope of PEP with doxycycline can hinder its effectiveness. Robust randomised controlled trials in the Indian population, particularly among high-risk groups, are crucial before incorporating PrEP/PEP with doxycycline into national guidelines. Emphasising the necessity for comprehensive assessments of safety and efficacy, including thorough monitoring of potential side effects, is imperative for ensuring the suitability of doxycycline in the specific context of the Indian population. Healthcare authorities and policymakers should also consider revising NACO guidelines to integrate PrEP and PEP with doxycycline for high-risk populations, such as MSM, CSWs, and transgender women with recent STIs while ensuring efficient resource allocation. Concurrently, we must bolster surveillance for antimicrobial resistance and improve resource availability, including self-testing kits, point-of-care tests, and STI vaccines.

Declaration of patient consent

Patient consent not required as there are no patients in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

References

  1. . International Institute for Population Sciences (IIPS), Mumbai, India. . p. :791-846.
  2. , , , . Changes in self-reported sexually transmitted infections and symptoms among married couples in India from 2006 to 2016: A repeated cross-sectional multivariate analysis from nationally representative data. BMJ Open. 2021;11:e049049.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  3. , , , , , , et al. Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: An open-label randomised substudy of the ANRS IPERGAY trial. Lancet Infect Dis. 2018;18:308-17.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , , , et al. Postexposure doxycycline to prevent bacterial sexually transmitted infections. N Engl J Med. 2023;388:1296-306.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  5. , , , , , . Doxycycline prophylaxis to reduce incident syphilis among HIV-infected men who have sex with men who continue to engage in high-risk sex: A randomized, controlled pilot study. Sex Transm Dis. 2015;42:98-103.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  6. , , , , , , et al. Doxycycline prophylaxis for bacterial sexually transmitted infections. Clin Infect Dis. 2020;70:1247-53.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  7. . Guidelines for the use of doxycycline post-exposure prophylaxis for bacterial STI prevention 2023. Available from: https://www.cdc.gov/std/treatment/guidelines-for-doxycycline.htm [Last accessed on 2023 December 5]

Fulltext Views
1,957

PDF downloads
663
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections