In the age of PrEP and the decrease in the use of condoms, there is an alarming STI epidemic. However, there is a morning-after pill to help avoid bacterial infection, called doxy PEP, which is short for post-exposure prophylaxis. It’s a single dose of doxycycline, an often-used antibiotic, taken within 24 hours of unprotected sex. I interviewed Dr. Perry N. Halkitis, an infectious disease epidemiologist, applied statistician, and public health psychologist, and currently Dean, Hunterdon Professor of Public Health & Health Equity, and Distinguished Professor of Biostatistics & Epidemiology at the Rutgers School of Public Health. He is also the founder and director of the Center for Health, Identity, Behavior and Prevention Studies.
What is the main reason we should be using doxy PEP?
Dr. Perry N. Halkitis: The bulk of the population has been overly focused on HIV at the expense of everything else. We are starting to get HIV under control but by no means completely under control. In the presence of PrEP and PEP for HIV, barriers are not frequently used for sexual encounters. Also, a chlamydia infection can be asymptomatic. Gonorrhea is particularly problematic because various versions are floating around, some of which are resistant to current first-line treatment. Containing those bacterial STIs, in my perspective, is an essential complement to HIV PrEP and PEP for sexual health.
Is one given a typical dose, or is it less?
PH: It is not being dosed at the same rate as it would be dosed at if someone were being treated for something. It’s two pills 24 hours after exposure. By the way, there is experimentation going on for using it as a pre-exposure prophylactic.
What is the danger of antimicrobial resistance?
PH: If there is anything that is the alarm bell for doxy PEP, given the amount of antibiotic resistance out there, do we want to continue to prescribe something that people are going to be taking in this more haphazard fashion, than might normally be prescribed for the use of antibiotics? I think the benefits outweigh the risks because controlling STIs is also critical in controlling HIV. We know that people who have STIs are more likely to acquire HIV. And we know people aren’t using condoms.
Do you think that having doxy PEP as an option will encourage people to have less safe sex?
PH: I think this will add a layer of protection to something people are already doing. It won’t encourage people to have more unprotected sex. The more you empower people to take care of their sexual health by giving them HIV PrEP and PEP and doxy PrEP and PEP, the better we can control the epidemics within the community itself.
With doxy PrEP, would someone always be on it?
PH: No, they would take it right before. I think they are testing 24 hours before an encounter.
Is there anything else you would want people to know about doxy PEP?
PH: It’s overall very beneficial, but not foolproof, especially for gonorrhea, but better than nothing. If you’re not going to be using a condom, then use this.
I enjoyed speaking with Dr. Halkitis about such issues. I found this interesting in his bio: “For three decades, the focus of his research has been on the emergence, prevention, and treatment of infectious diseases in sexual, gender, and/or racial-ethnic minority populations. In addition, Dr. Halkitis has been on the forefront of fighting for the rights of those infected with and affected by HIV, as well as being an outspoken advocate for the rights and health of the LGBTQ population.”
