DoxyPrEP may reduce sexually transmitted infections in female sex workers, study finds

News brief

A study of female sex workers in Japan found that doxycycline pre-exposure prophylaxis (doxyPrEP) is tied to significantly reduced overall incidence of sexually transmitted infections (STIs) without increasing other vaginal infections, researchers reported today in JAC-Antimicrobial Resistance.

The study, conducted by researchers with the Japan Institute for Health Security, involved 40 cisgender female sex workers who initiated a daily prophylactic 100-milligram dose of doxycycline for STI prevention from October 1, 2022, to November 14, 2023. Data on incidence of chlamydia, gonorrhea, syphilis, bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC) were collected before and after doxyPrEp initiation. The study authors note that the participants were also given the choice of doxyPEP, a strategy that involves taking a higher dose of the antibiotic after unprotected sex, but they chose doxyPreP because of its convenience, a potentially lower incidence of side effects, and improved adherence.

The overall STI incidence rate after doxyPrEP initiation fell from 232.3 to 79.2 per 100 person-years (incidence rate ratio [IRR], 0.33 years; 95% confidence interval [CI], 0.13 to 0.84). The reduction was driven primarily by a drop in syphilis infections to zero, while the reduction in chlamydia incidence showed marginal statistical significance and gonorrhea showed no statistically significant reduction. Similarly, no significant changes were observed in BV or VVC incidence.

Follow-up clinical evaluations on 22 participants found that adherence to doxyPrEP was high, with most participants reporting no missed doses, and that satisfaction with the strategy was likewise high. No serious adverse events were reported.

Further studies are needed

The findings are noteworthy, because a previous randomized controlled trial in Kenya found that doxyPEP was not effective in preventing bacterial STIs in cisgender women. Experts have suggested that those results might be attributed to low adherence. In this study, adherence was high.

The study authors say, however, that the results of their small, single-center study should be interpreted with caution.

"Further large-scale, controlled studies are needed to validate these findings, assess long-term effectiveness, and evaluate the potential impact on antibiotic resistance and broader public health implications," they wrote.

Switzerland confirms clade 1b mpox as Hong Kong issues warning

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Stephanie Soucheray, MA

A traveler returning to Switzerland from Africa has been confirmed to have clade 1b mpox. This is the first detection of clade 1b in Switzerland, which is more virulent compared to the clade 2 virus that circulated the globe in 2022 primarily among men who have sex with men.

"The person concerned is in isolation. There is no risk of infection to others," the Swiss Federal Office of Public Health said.

The person concerned is in isolation. There is no risk of infection to others.

Clade 1b is fueling a central Africa mpox outbreak, with the Democratic Republic of the Congo seeing the most cases.

Honk Kong urges vigilance after UK detection

At least 15 countries in Asia, Europe, and North America have now confirmed clade 1b detections, almost all travel related. However, earlier this week the UK Health Security Agency said it has recorded a clade 1b case in a patient with no history of travel to outbreak areas and no contact with any known case-patients.

In response to the UK case, Hong Kong health officials are warning people to be vigilant about mpox. Hong Kong has not yet detected any clade 1b infections.

So far this year, Hong Kong has reported only 4 mpox cases and 72 since 2022.

Quick takes: H5N1 death in Mexico; Kenya cholera outbreak; H5N1 virus in cows, poultry, cats

News brief

Lisa Schnirring

A 3-year-old girl from Mexico who was recently hospitalized with H5N1 avian flu has died from her infection, Mexico’s government announced yesterday. In a statement, the government said the girl died due to respiratory complications of her illness. The girl’s case marked Mexico’s first from H5N1 and the second fatal case this year in North America. Also, a severe illness was reported in late 2024 in a Canadian teen. So far, it's not known how the Mexican girl contracted the virus or what H5N1 genotype was involved.
Kenya’s health ministry yesterday declared a cholera outbreak, with illnesses reported in three counties, mostly in Migori and Kismu counties in the west but with some cases reported from Nairobi County in the west central part of the country. On X, the ministry said 97 cases have been reported, 6 of them fatal. Officials have stepped up surveillance and are urging community members to report cases quickly. In a recent cholera update, the World Health Organization (WHO) said Africa is currently experiencing the highest burden this year, with 14 countries reporting cases, mostly from South Sudan, the Democratic Republic of the Congo, and Angola.
The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) today reported 3 more H5N1 avian flu detections in dairy cattle, all from Idaho, pushing the national total to 1,005 and Idaho’s total to 52. Also, APHIS confirmed two more detections in poultry flocks, both at commercial farms—one at a turkey farm in South Dakota and the other at a producer in Wisconsin. The agency also reported eight more confirmations in other mammals, including pet cats from three states: California, Colorado, and Ohio. The other detections involved a mink in Ohio and a skunk in Texas.