Real-World Data Yields Promise for DoxyPEP

By: Ranier Simons, ADAP Blog Guest Contributor

Sexually transmitted diseases (STIs) are serious, highly communicable diseases that, left unchecked, can cause serious harm and even be life-threatening. Some, such as HIV, are incurable. Others can be disfiguring, cause sterility, or even brain damage and congenital abnormalities. (NIH, 2017). Three of the most common curable STIs are syphilis, chlamydia, and gonorrhea. In the U.S., over 2.4 million cases of syphilis, gonorrhea, and chlamydia combined were diagnosed and reported in 2023. (Press, 2024). A recent treatment innovation being adopted in the fight against STIs is doxycycline post-exposure prophylaxis, commonly referred to as doxyPEP. Clinical trials have shown promising results, and recent data shows the promise of its effectiveness in real-world populations of sexual networks.

Photo Source: Chicago Department of Public Health

DoxyPEP is the administration of 200 mg of doxycycline within 24 hours of unprotected sex. (Lou, 2025). Two previous clinical trials, the DOXY/PEP study in the U.S. and the DOXYVAC study out of France, indicate that DoxyPEP is effective for STI prevention. However, the sample sizes of the studies were small, and it is necessary to investigate the effectiveness of the intervention on larger populations out in the real world. The DOXY/PEP study contained 501 participants, and the DOXYVAC study included 556. (Molina, 2024; Susman, 2022). Two recent studies indicate the high efficacy of more extensive population-level doxyPEP implementation. One study was conducted in San Francisco, and the other studied populations in Northern California.

The study out of San Francisco was a population-level interrupted time series analysis of STI cases of men who have sex with men (MSM) and transgender women before and after the city issued citywide doxyPEP guidelines in 2022. (Sankaran, 2025) During the study period, there were 6694 cases of chlamydia, 9603 cases of gonorrhea, and 2121 cases of early syphilis. The study's objective was to observe the percentage differences between STI-modeled projected infections and observed STI rates after citywide doxyPEP was initiated. By the end of the study period, chlamydia cases had decreased -49.64% and early syphilis cases by -51.39% compared to projected case levels. However, there was an increase in gonorrhea cases compared with projections.

The Northern California study was a retrospective cohort examination of adult Kaiser Permanente Northern California (KPNC) members who were given HIV PrEP from November 1, 2022, through December 31, 2023. (Trager, 2025) In the study of 11,551 subjects, 2253 were dispensed doxyPEP. The primary outcome of the study was the examination of quarterly rates of STI positivity. Among those on doxyPEP, quarterly chlamydia positivity decreased from 9.6% before doxyPEP administration to 2.0% after. Gonorrhea positivity decreased from 10.2% to 9.0%. Syphilis positivity lowered from 1.7% to 0.3%. Rates remained stable among those who were not utilizing doxyPEP.

The CDC has officially recommended the use of doxyPEP for STI prevention for MSM and transgender women since June of 2024. (Lou, 2025). Counseling for doxyPEP is especially encouraged for members of this population who have had at least one STI infection in the past year. Notably, doxyPEP has had questionable efficacy related to gonorrhea. In the San Franciso study, there was an increase in gonorrhea cases. The Kaiser Permanente study showed lower rates of gonorrhea positivity in rectal and urethral site infections with an increase in pharyngeal gonorrhea rates. These findings support the hypothesis that pharyngeal tissues could be a reservoir of gonorrheal antibacterial resistance and the possibility of increased risk of gonorrheal antibacterial resistance overall.

These aforementioned studies indicate that doxyPEP is potentially an efficacious modality of STI prevention not just in clinical studies but also out in the real world. However, larger, more targeted studies must be conducted on wide populations to gain a deeper understanding. The San Francisco and Kaiser Permanente studies only show a correlation and not a causal relationship between doxyPEP and lowered STI rates because the studies are observational. Regardless, doxyPEP is making a significant dent in STI transmissions and only time will reveal its true efficacy and possibility of antibiotic resistance risk.

Photo Source: San Francisco City Clinic

[1] NIH. (2017). Why are sexually transmitted diseases (STDs) and sexually transmitted infections (STIs) of particular concern for pregnant women? Retrieved from  https://www.nichd.nih.gov/health/topics/stds/conditioninfo/concern#:~:text=STIs%20during%20pregnancy%20can%20also%20cause:&text=Miscarriage%20(fetal%20loss%20before%2020,Health%20complications%20in%20the%20mother

[2] Lou, N. (2025, January 6). DoxyPEP Rollout Tied to Dent in STI Epidemic in the Real World. Medpagetoday.com; MedpageToday. Retrieved from https://www.medpagetoday.com/infectiousdisease/stds/113668

[3] Molina, J.-M. (2024). Doxycycline prophylaxis and meningococcal group B vaccine to prevent bacterial sexually transmitted infections in France (ANRS 174 DOXYVAC): a multicentre, open-label, randomised trial with a 2 × 2 factorial design. Lancet. Infectious Diseases/˜the œLancet. Infectious Diseases. https://doi.org/10.1016/s1473-3099(24)00236-6

[4] Press, A. (2024, November 13). STI Epidemic Slows as New Syphilis and Gonorrhea Cases Fall in the U.S. Medpagetoday.com; MedpageToday. Retrieved from https://www.medpagetoday.com/infectiousdisease/stds/112879

[5] Sankaran, M., Glidden, D. V., Kohn, R. P., Nguyen, T. Q., Bacon, O., Buchbinder, S. P., Gandhi, M., Havlir, D. V., Liebi, C., Luetkemeyer, A. F., Nguyen, J. Q., Roman, J., Scott, H., Torres, T. S., & Cohen, S. E. (2025). Doxycycline Postexposure Prophylaxis and Sexually Transmitted Infection Trends. JAMA Internal Medicine. Retrieved from  https://doi.org/10.1001/jamainternmed.2024.7178

[6] Susman, E. (2022, July 29). Post-Exposure Doxycycline Reduces STIs. Medpagetoday.com; MedpageToday. https://www.medpagetoday.com/meetingcoverage/iac/99983

[7] Traeger, M. W., Leyden, W. A., Volk, J. E., Silverberg, M. J., Horberg, M. A., Davis, T. L., Mayer, K. H., Krakower, D. S., Young, J. G., Jenness, S. M., & Marcus, J. L. (2025). Doxycycline Postexposure Prophylaxis and Bacterial Sexually Transmitted Infections Among Individuals Using HIV Preexposure Prophylaxis. JAMA Internal Medicine. Retrieved from https://doi.org/10.1001/jamainternmed.2024.7186

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

Surge in STI Rates Cause Alarm

By: Ranier Simons, ADAP Blog Guest Contributor

Public health in the United States has been challenged heavily in recent years with the coronavirus, meningococcal disease, and monkeypox virus. Newly released data, from the U.S. Centers for Disease Control & Prevention (CDC), paints a grim picture evidenced by the rates of sexually transmitted infections (STIs) sharply increasing during this time.[1] Personal behavior choices, regarding sexual activity, are one of many factors contributing to unfavorable STI numbers. For example, research is indicating that MSM (men who have sex with men) who are taking PrEP are using condoms less.[2] The protection provided by PrEP against HIV is causing MSM to have a false sense of security even though it does not protect against other STI’s.[3] However, behavior modification is only part of the discourse towards solutions.[4] Issues with insufficient public health funding, persistent social stigma, demonizing politics, and inconsistent policy comprise the scaffolding that undergirds the increased STIs rates.

Photo Source: ACT for Youth

Recent CDC reporting of the preliminary data indicates 2.5 million reported cases of chlamydia, gonorrhea, and syphilis in 2021.[1] The numbers will increase as 2021 numbers continue to be reported in 2022. New cases of chlamydia, gonorrhea, and syphilis all increased. In 2021, syphilis infection rates reached the highest level since 1991 and the total number of cases was the highest since 1948.[5] There was a 26% increase in new syphilis infections from 2020 to 2021 in contrast to a 7% increase from 2019 to 2020.[6] The number of gonorrhea and chlamydia infections increased 4%. HIV cases also increased 16% in 2021 from 2020.[5] Increased numbers of congenital syphilis cases coincided with the increase in overall syphilis infections. Higher congenital syphilis numbers mean more child deaths, deformities, blindness, and stillbirths.[5]

Higher STI numbers indicates increases in sexual activity. Surges in sexual activity can partially be attributed to people becoming more active as covid lockdowns ended and people relaxed their social distancing practices. Data also indicates increased substance abuse during the pandemic has led to more unprotected sex and other less safe sexual practices.[5] 

Prevention and treatment are the best ways to combat STIs. However, existing barriers hamper  efforts. During the pandemic, many people lost their jobs which meant a loss of health insurance. Additionally, many free clinics paused in-person testing and some closed. Funding issues existed even before the pandemic. Elizabeth Finley, Director of Communications for the National Coalition of STI Directors states: “The programs and safety net clinics that provide essential services have long been operating on shoestring budgets and are at a breaking point – a trend accelerated by the devastating impact of COVID-19 and monkeypox…It’s long past time to increase program budgets so that they can respond to the exploding number of infections in their communities and to create a dedicated funding stream for STI clinical services.”

The federal Title X program is an example of a funding challenge. In its most recent spending bill, Congress kept the program funding flat at $286 million dollars instead of increasing it. Many state health departments and independent sexual health clinics are part of the Title X family planning program. Keeping funding flat means that the U.S. Department of Health and Human Services had to shift resources to try and reach the areas of the country with the most need. Thus, many providers in the program, in states with high STI rates, received large budget cuts.[7] Title X providers reach those who fear getting an STI test or treatment at a regular doctor’s office for fear of it showing up on insurance statements; especially youth still on parents’ insurance policies. 

Photo Source: Signature Care

Jen Laws, President and CEO of Community Access National Network, states: “Social stigma associated with sex is an extraordinary contributing factor in both the rise of STIs and the refusal of legislators to appropriately fund treatment and prevention programs. The current socio-political environment is toxic – rhetoric demonizing LGBTQ people and ignoring the educational needs of adolescents only fosters an environment where it's increasingly dangerous for patients to seek the care and advice they need to navigate a healthy sex life.”

The Biden Administration has proposed to increase Title X funding to $400 million for 2023, but that will not help the current situation. Other solutions involve the current infrastructure as well as private industry. Leandro Mena, the CDC’s director of STI prevention, suggests that drug addiction treatment facilities should add STI services, and the private sector needs to develop more effective STI tests, treatments, and vaccines.[7] Home test kits for STI’s would be a worthwhile private sector development effort. Kits will make it easier for people to find out if they have an STI as well as take steps to prevent spread in the same manner that home coronavirus test kits do.

A multi-pronged approach is required to battle surging STI rates. Proper funding is required, private sector interest and innovation is necessary, normalizing sexual health as a part of wholistic healthcare, and increasing education efforts. Even though money is a large part of the equation, a paradigm shift is also key to effective change.

[1] CDC. 2022. Preliminary 2021 STI Surveillance Data. Retrieved from https://www.cdc.gov/STI/statistics/2021/default.htm
[2] Hendrie, D. (2018, June 7). Rapid uptake of PrEP linked to declining condom use. Retrieved from https://www1.racgp.org.au/newsgp/clinical/rapid-uptake-of-prep-linked-to-declining-condom-us
[3] Nelson, R., Nagata, J. Condom Use for Anal Sex in the Era of Pre-exposure Prophylaxis (PrEP). Journal of Adolescent Health. 2022. 71(2). 245. DOI: https://doi.org/10.1016/j.jadohealth.2022.05.014
[4] Samuel, K. (2020, Nov 30). How PrEP users decide whether to use condoms. Retrieved from https://www.aidsmap.com/news/nov-2020/how-prep-users-decide-whether-use-condoms
[5] Stobbe, M. (2022, September 19). Out of control STI situation prompts call for changes. Retrieved from https://apnews.com/article/monkeypox-science-health-covid-epidemics-aaac64591251293f45c225d3fe963d0c?utm_campaign=KHN%3A%20First%20Edition&utm_medium=email&_hsmi=226604169&_hsenc=p2ANqtz-9DxmD1qskNMHydAQMYYJt6z-rEy9GkI1vckbWlm85Rf6g4BgWoG5YdpKYLf4iD7wLXHxxFxmWJ3bIHEHk5BX0HmKU0Ng&utm_content=226604169&utm_source=hs_email
6] Muller, M. (2022, September 19) Syphilis cases in the US Surged 26% last year, along with other STIs. Retrieved from https://www.bloomberg.com/news/articles/2022-09-19/us-sees-sharp-rise-in-some-sexually-transmitted-infections
7] Ollstein, A. (2022, April 12) STIs are surging. The funding to fight them is not. Retrieved from https://www.politico.com/news/2022/04/12/STIs-funding-00024678

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

CDC Reports Record-Breaking STD Cases

By: Jonathan J. Pena, MSW, Licensed Clinical Social Work Associate (LCSWA)

In life, being at the top has always been a driving force of accomplishments, recognition, and even bragging rights. We see this playout in areas like sports, personal careers, and even friendly rivalries between family and friends. However, rising to the top isn’t always a place that you would want to find yourself in. Sexually transmitted diseases (STDs) have been on the rise for six uninterrupted years. 

The Center for Disease Controls and Prevention (CDC) released data demonstrating that “more than 2.5 million cases of chlamydia, gonorrhea, and syphilis” were reported in 2019.[1] In their last report in 2014, 1.4 million cases were reported giving way to a 1.1 million increase in cases to date. Some states have reached the top ten list of states with the highest cases of either chlamydia, gonorrhea, or syphilis. Additionally, the rises in STD’s exposes what communities are being hit hardest.

Photo Source: USA Today

Chlamydia is a curable infection, but it can be spread through vaginal, oral and anal sex with an infected person. States like New York, Illinois, North Carolina, Georgia, Alabama, Alaska, Louisiana, Mississippi, South Carolina, and New Mexico ranked in the top ten with the highest cases of chlamydia. New Hampshire has the lowest total cases of 2019.[2]

Gonorrhea cases were highest in Mississippi, South Carolina, Alaska, Alabama, Oklahoma, Louisiana, Missouri, South Dakota, North Carolina, and Tennessee. Much like Chlamydia, Gonorrhea is a common STD and spread in the exact same way. However, there are some important factors that set it apart. First, “young people ages 15-24 years” are being infected and like other infections, this can present complications for a pregnant mother as she can pass the infection to their child at birth.[3] This infection is curable but drug-resistant strains have emerged making it harder and harder to treat the infection. Vermont is the state with the lowest cases. 

Like the previous two infections, Syphilis is spread sexually by an infected person with a syphilitic sore or otherwise known as a chancre sore.[4] Also, like the previous infections, syphilis can be spread to a new-born child during birth from an infected mother. According to the CDC, if a mother does not treat her infection, congenital syphilis can lead to “miscarriages, premature births, stillbirths, and deaths of newborns.”[5] States that hit the top ten are New Mexico, Mississippi, Nevada, Oklahoma, California, Alaska, Arizona, Georgia, Florida, and Louisiana. 

This data certainly is alarming, but these cases also bring to the surface all too familiar disparities that persevere within minority groups. When compared to non-Hispanic white people, STD rates were 1-2 times higher within Hispanic or Latino populations. American Indian, Alaska Native, Native Hawaiian, Pacific Islanders face rates 3-5 times greater than non-Hispanic white populations. African Americans face rates 5-8 times higher than non-Hispanic white populations.[6] 

Marcus J. Hopkins, Operations Manager for the Community Education Group (CEG) & Project Manager for the Rural Health Service Providers Network, highlights some key factors in these findings. He states, “"When you look at the list of states where rates of STDs/STIs have skyrocketed, with rare exception, the same group of states saw dramatic increases—Alabama, Alaska, Georgia, Louisiana, Mississippi, North Carolina, Oklahoma, & South Carolina. These states share several characteristics: high levels of endemic poverty, significant barriers to accessing basic healthcare services, highly restrictive public health programs and systems, and low levels of health literacy.”  

It isn’t hard to see how this statement from Marcus J. Hopkins rings true. These states have many pockets of rural communities which naturally present challenges in accessing healthcare miles from home. Rural communities also have a shortage of clinicians that are willing to work in these specific areas which further amplifies accessibility to healthcare services. Marcus J. Hopkins also adds, “outside of metro areas, it’s virtually unheard of for providers in rural areas to routinely test their patients for HIV, Viral Hepatitis, Chlamydia, Gonorrhea, and Syphilis. It is unconscionable for our public health infrastructure to serve only those in urban and suburban areas.” 

Photo Source: USA Today

While all groups experience STDs, minority groups continue to experience larger and larger disparities. Urban cities shouldn’t be the only hubs for healthcare accessibility nor the touchstones of greater public health care systems. Prominent public outreach is needed in rural communities that extends to not only access to healthcare services but also fosters programs that educate communities on the various and important aspect of health within a healthcare system. Minority populations also need targeted approaches to community health with clinicians of all kinds that culturally represent those within their communities. Representation matters because community members are more likely to seek services if there is an understanding that their healthcare system has clinicians, and programs, that understand their culture and thus can guide them towards a goal that addresses their specific needs. 

These consecutive rising rates of STD’s don’t need to become an expected yearly occurrence. While more work needs to be done on a macro-level to bridge healthcare disparities, people living with HIV/AIDS can still rise to meet the importance of their personal health. Continue to stay active in your care of not only HIV treatment but also in the value of understanding how all aspects of healthcare strengthen the ability to continue to lead a healthier life.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

[1] Centers for Disease Control & Prevention (April 2021). Reported STDs in the U.S. reach all-time high for 6th consecutive year. U.S. Department of Health & Human Services. Retrieved online from: https://www.cdc.gov/std/statistics/2019/default.htm. 

[2] Gabriella, M. (2021, June 15). STDs reach all-time high for sixth consecutive year in the US. Is your state in the top 10? USA Today. Retrieved online from: https://www.usatoday.com/story/news/health/2021/06/15/std-rates-reach-all-time-high-us-which-states-have-most-cases/7700643002/. 

[3] Gabriella. STDs reach all-time high for sixth consecutive year in the US. Is your state in the top 10?.

[4] Gabriella. STDs reach all-time high for sixth consecutive year in the US. Is your state in the top 10?.

[5] Gabriella. STDs reach all-time high for sixth consecutive year in the US. Is your state in the top 10?.

[6] Gabriella. STDs reach all-time high for sixth consecutive year in the US. Is your state in the top 10?.