RFSL about Doxy-PEP

In April 2024 QX magazine published an article from health care workers from some of the largest infection clinics with a long experience of working with men who have sex with men and trans persons. Read the article in Swedish here.

The reason why they chose to issue a warning is the concern that Doxycycline will become less effective in the future in the treatment of venereal diseases. There is also concern that the spread of resistant gonorrhea will increase at an even faster rate than today. Doxy-PEP does not provide 100% protection against syphilis and chlamydia. A single dose does not replace a full course of treatment in the case of a diagnosed infection. Anyone who has a sexually transmitted disease without symptoms can therefore pass on the ongoing infection. Another risk is that you don’t go and test yourself to the same extent.

In Sweden, multi-resistant bacteria are not a big problem yet, as we are more restrictive with prescribing antibiotics than in other countries. This does not mean that we can take repeated single doses without risking multi-resistant bacteria becoming a problem in the future. Doxycycline is also used in other bacterial infections such as pneumonia, chronic bronchitis, Lyme disease and in treatment in patients who are allergic to penicillin. If the bacteria become resistant to Doxycycline, we risk not being able to offer an effective treatment.

If you have an ongoing venereal disease that hasn’t shown symptoms, it is not cured by a single dose, but a complete treatment for 10-14 days is needed, otherwise there is a risk that the infection will return, or remain.

Doxycycline and other drugs

Doxycycline should be prescribed by a doctor who can make an assessment about safety, risks and altered effects in combination with other drugs. Doxycycline increases the risk of allergic skin reactions and you should therefore avoid direct sunlight and solariums for 5 days after finishing treatment. Some people may get skin rashes and ulcers from Doxycycline (“fixed drug eruption”). During treatment with Doxycycline, the effect of other medicines can be affected (reduction or increase of the effect, either of doxycycline or of the other medicine), for example medicines for the treatment of acid reflux, iron medicine, calcium supplements, epilepsy medicines, blood pressure medicines, blood thinning medicines, medicines against viral infections as well as drugs against malaria. Doxycycline must never be taken at the same time as Isotretinoin, which is an anti-acne medication, as this can cause increased pressure in the brain. Alcohol can also sometimes affect the effect of Doxycycline. Questions about the effects of different medications on each other (drug interactions) can be complicated and cannot be easily summarized. This is one of the reasons why the healthcare system in Sweden thinks that doctors need to be involved in order to make an assessment and be able to handle any problems.

You who receive Doxycycline in a way other than via the healthcare system should have an understanding of what you are taking and why. It is for your safety, health and so that you can be treated with Doxycycline in the future when you may actually need it.

In the future, we may also recommend Doxy-PEP in Sweden, but for it to become relevant, more research and knowledge about the consequences of it is needed. Antibiotics are among the most important resources we have to treat various diseases, and without that option, previously easily treated infections can become more difficult and create unnecessary suffering.

In summary

RFSL has full confidence in the recommendations and concerns expressed by experienced doctors and nurses at some of the country’s largest infectious diseases clinics. Therefore, we instead recommend that you who have condomless sex go and get tested regularly for sexually transmitted diseases and in case of symptoms, in order to be able to receive treatment when needed.