Atlanta, Georgia – The Centers for Disease Control and Prevention (CDC) recently released new guidelines developed by a multidisciplinary workgroup focusing on the potential benefits of using doxycycline as a post-exposure prophylaxis (PEP) for bacterial sexually transmitted infections (STIs) like syphilis, chlamydia, and gonorrhea. The aim of the guidelines was to investigate if taking doxycycline after engaging in vaginal, anal, or oral sex could reduce the risk of contracting bacterial STIs compared to not taking the medication.
To inform their recommendations, the CDC workgroup conducted a thorough systematic literature review, considering studies published up to June 2023 from databases like MEDLINE/PubMed and Embase. They evaluated randomized controlled trials written in English that specifically looked at the use of doxycycline as STI prophylaxis, using a rigorous rating system to assess the strength of evidence. Additionally, the workgroup utilized the Grading of Recommendations, Assessment, Development, and Evaluations framework to weigh the benefits and potential harms, as well as factors like feasibility and acceptability.
Experts and stakeholders convened virtually in December 2022 for a 2-day consultation organized by the National Association of County and City Health Officials to discuss the implications of using doxycycline PEP. The insights and findings from this meeting were crucial in shaping the CDC’s recommendations. Subsequently, a bioethics consultation in April and May 2023 involving bioethics experts, infectious disease specialists, community advocates, and CDC staff further informed the development of the guidelines.
The workgroup engaged in a rigorous peer review process, seeking input from diverse experts in infectious diseases, STI prevention, and antimicrobial resistance. Reviewers were asked specific questions related to the draft recommendations and any potential conflicts of interest were disclosed and addressed. The final recommendations underwent a 45-day public comment period starting October 2, 2023, allowing for feedback from both peer reviewers and the public to be incorporated into the revised document.
Recognizing the complexity of the populations at risk, the report acknowledges the importance of considering various factors such as gender identity, sexual orientation, and sexual behavior in assessing the likelihood of bacterial STI transmission. This holistic approach aims to tailor recommendations to the specific needs of individuals based on their unique circumstances.