Research shows an increase in informal use of Doxypep/Prep among key populations in the Netherlands

Research shows an increase in informal use of Doxypep/Prep among key populations in the Netherlands

New research analysis of an online survey of 1,633 respondents found a 15% increase in recent use of doxycycline post- and pre-exposure prophylaxis (Doxypep/Prep) among men who have sex with men (MSM), transgender and gender in the U.S., according to a recently published study published by published studies published by published studies published by a recently published study published by published by published studies published by a recently published study.Eurosurveillance. These data highlight an increase in informal use of Doxypep/Prep, with 65% of participants intending to use them in the future. Currently, Doxypep/Prep is not recommended or actively promoted by healthcare professionals in the Netherlands. Informal use of IU without a prescription from a healthcare professional could contribute to antimicrobial resistance (AMR) and microbiome changes.

The use of Doxypep has been shown to be an effective method in the prevention against sexually transmitted infections (STIs) in MSM, transgender and gender diverse people. Clinical trials with Doxypep have shown significant reductions in syphilis and chlamydia, with additional potential to reduce other bacterial STIs such as chlamydia and gonorrhea

However, the public health implications of widespread use of Doxypep are subject to current debate. Giving Doxypep to certain people could prevent a significant number of STIs and reduce antibiotic use, especially in those who have repeated STIs.

Informal DOXYPEP/PREAP use related to HIV preparation, sexualized drug use, and perceptions of safety

As demonstrated by this paper and an accompanying editorial by Lyons et al. Evidence shows that prescribing doxypep to large numbers of sexually active individuals poses a risk of a significant increase in overall consumption at the population level and an increase in AMR.

Teker et al. Reviewed data from a cross-sectional study derived from an online survey of MSM, transgender, and gender diverse individuals aged 18 years or older. The survey focused on prior use of Doxypep or Doxyprep awareness and intention to use. Participants were recruited through advertisements at the Sexual Health Center in Amsterdam, the Netherlands, as well as dating apps (Grindr), Instagram, Facebook, Facebook Messenger, and targeted Instagram accounts at the Sexual Health Center.

In the study, 23% of participants reported using DOXYPEP/PREP and 15% reported using DOXYPEP/Prep in the six months prior to the survey. Respondents who were informed of recent use were more likely to report having HIV or frequent use of oral HIV preparation in the six months prior to survey administration. They were also more likely to report a history of bacterial STIs, with a higher number of sexual partners and a higher frequency of chemsex and group sex during this period.

Doxycycline was the most commonly used antibiotic reported in this study. 46% of participants reported recent use of PEP, 29% of recent PEP users reported use of it as preparation, and 25% who used it as a combination of both.

Overall, intention to use Doxypep/Prep was very high in the study population, with more than half of participants (65%) indicating intention to use. More than two-thirds of respondents (72%) were willing to pay for Doxypep/Prep if it became officially available, indicating potential demand for the drug in the study population and beyond.

It was also found that Doxypep/Prep was mainly obtained from countries outside the Netherlands or through prescriptions, with participants paying on average €30 for the drug.

Additional determinants of both informal use of Doxypep/Prep and high intention to stop using oral HIV preparations or living with HIV, advice received from others regarding use of Doxypep/Prep and perception of Doxypep/Prep as an effective and safe method of STI prevention.

Possible risks of antimicrobial resistance due to lack of surveillance

The impact of prophylactic antibiotic use on AMR was highlighted in the study as there is uncertainty regarding the long-term adverse effects of Doxypep/Prep use. Teker et al. emphasize the potential harms of doxycycline efficacy and AMR risks, as summarized in previous studies, including in the US.

They also cite its potential effects on the gut microbiome, which requires further study. If doxypep were to be implemented into nationwide clinical guidance, it would be important to monitor both individual and population-level resistance to doxycycline.

The lack of awareness of the extent of informal use of Doxypep/Prep makes it difficult to monitor and implement appropriate public health stewardship. This leads to difficulties in detecting overuse, misuse and adverse effects, including AMR development and effects on microbiome composition.

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