Analysis finds doxyPEP reduces antibiotic use for STIs

News brief

Among a cohort of men who have sex with men (MSM) at an Italian hospital, a significant reduction in all antibiotics used to treat bacterial sexually transmitted infections (bSTIs) was observed after the introduction of doxycycline post-exposure prophylaxis (doxyPEP), researchers reported late last week in the Journal of Antimicrobial Chemotherapy.

The retrospective study examined antibiotic use for bSTIs among MSM in care for HIV or on HIV pre-exposure prophylaxis at a hospital in Milan who received doxyPEP from August 2022 through July 2024. Prescriptions for doxyPEP, which involves taking a single dose of doxycycline within 72 hours of unprotected sex to prevent bSTIs, were limited to MSM who had five or more casual sex partners.

The primary outcomes were the incidence rate of bSTIs and days of therapy (DOT) per 1,000 patient-days (PD) for ceftriaxone (gonorrhea), benzylpenicillin (syphilis), and doxycycline (chlamydia) for bSTI treatment before and after doxyPEP prescription.

Overall reduction in antibiotic use

Overall, 754 MSM were prescribed doxyPEP during the study period, and 222 (29.4%) reported using it during follow-up.

Among doxyPEP users, 401 bSTIs were detected before prescription and 146 after. DOT per 1,000-PD was 1.26 for ceftriaxone, 0.37 for benzylpenicillin, and 3.21 for doxycycline after prescription, while doxyPEP DOT per 1,000-PD was 7.00. The expected DOT in the absence of doxyPEP was 4.85 (95% confidence interval [CI], 3.82 to 6.41) for ceftriaxone, 1.86 (95% CI, 1.17 to 2.87) for benzylpenicillin, and 24.71 (95% CI , 17.18 to 37.36) for doxycycline.

Previous research has estimated that widespread doxyPEP use could lead to a significant increase in doxycycline use, which has raised concerns that the strategy could promote antimicrobial resistance (AMR). But the authors of the study say the more targeted strategy they used, with a focus on men with a substantial risk of bSTIs, could result in an overall reduction in antibiotic use.

"By preventing the occurrence of bSTIs, doxyPEP may help to reduce the need for therapeutic antimicrobial treatment," they wrote. "This prophylactic approach could lead to a reduction in overall antimicrobial use, potentially mitigating some of the risks associated with widespread antimicrobials use, such as the development of AMR."

Quick takes: Chikungunya in Cuba, rapid filovirus test, World Hepatitis Day

News brief

Lisa Schnirring

Cuban health officials have reported a chikungunya outbreak in a newly affected area, Matanzas province in the west central region, according to News Digitales, a news service based in Argentina. The infections are occurring in the city of Perico, and health officials issued an alert after infections were confirmed by Cuba’s Pedro Kouri Institute of Tropical Medicine, which promoted an emergency response that include fumigation, larvicide distribution, and educating the community about eliminating mosquito breeding sites. Cuba recorded its first chikungunya cases in 2014. Other regions of the world are also reporting chikungunya outbreaks, including China, where health officials are now reporting more outbreaks in Guangdong province beyond the initial hot spot in Foshan to include Guangzhou, Zhongshan, and nine other cities, The Standard, an English-language newspaper based in Hong Kong, reported yesterday. The province has now recorded 4,824 cases, most of them in Foshan.
Aptitude Medical Systems today announced that it has signed a partnership with the Biomedical Advanced Research and Development Authority (BARDA), part of the US Department of Health and Human Services (HHS), that includes $9 million to develop a rapid molecular test to detect and differentiate Ebola and Marburg virus species. In a statement, the California-based company said the small, portable platform would be appropriate for use in remote or point-of-care settings and can deliver a result in 30 minutes from a venous or fingerstick blood sample. The test builds on the company’s Metrix molecular diagnostic platform, which was advanced through an earlier BARDA contract.
Global health groups today marked the annual observance of World Hepatitis Day, including the World Health Organization, which called on governments and partners to take urgent steps to eliminate viral hepatitis as a public health threat and reduce liver cancer deaths. Hepatitis B, C, and D are among the causes of acute liver infection, which can lead to chronic illness and result in cirrhosis, liver failure, or liver cancer. The WHO said those three subtypes affect 300 million people globally and cause 1.3 million deaths each year. It noted that hepatitis D is now classified as carcinogenic to humans, along with hepatitis B and C. Hepatitis D is known to only strike people infected with hepatitis B and is linked to a two- to six-fold increased risk of liver cancer compared with hepatitis B alone.