Boschiero Matheus Negri, Sansone Nathália Mariana Santos, Matos Laura Ribeiro, Marson Fernando Augusto Lima
Sex Transm Dis. 2025 Feb 1;52(2):65-72. doi: 10.1097/OLQ.0000000000002082. Epub 2024 Sep 24.
Bacterial sexually transmitted infections (STIs), specifically infection by Chlamydia trachomatis , Neisseria gonorrhoeae , and Treponema pallidum , have an important burden worldwide. The use of doxycycline as preexposure prophylaxis (PREP or doxy-PREP) or postexposure prophylaxis (PEP or doxy-PEP) might be effective as prophylaxis because it is effective against C. trachomatis and T. pallidum .
Our objective was to evaluate the efficacy of doxycycline as PREP or PEP against bacterial STIs ( C. trachomatis , N. gonorrhoeae , and T. pallidum ).
A systematic review and meta-analysis of randomized clinical trials of a high-risk group of individuals was conducted to evaluate whether doxycycline is as effective as PREP or PEP in preventing bacterial STIs. The PubMed-MEDLINE (MEDlars online), Cohrane, Scientific Electronic Library Online (SciELO), and Latin America and the Caribbean Literature on Health Sciences ( Literatura Latino-Americana e do Caribe em Ciências da Saúde -LILACS) databases were searched for randomized clinical trials published up to March 2024. Data were extracted from published reports. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence interval (CI) were pooled across trials.
The primary end points were any incidence of bacterial STIs and individual STI infections.
A total of 4 studies were included in the analysis, 3 of which evaluated doxy-PEP and 1 evaluated doxy-PREP. In the doxy-PEP group, a total of 1182 participants were evaluated. In the pooled analysis of doxy-PEP studies, the incidence of the first STI was lower in the doxy-PEP group (HR, 0.538 [95% CI, 0.337-0.859]; I2 = 77%; P < 0.05). Regarding individual infections, only 2 studies were included. In the doxy-PEP group, the incidence of individual infection of C. trachomatis was lower compared with controls (RR, 0.291 [95% CI, 0.093-0.911]) ( I2 = 89%; P < 0.05). Because only one study evaluated doxy-PREP, it was not possible to calculate a meta-analysis index; however, the use of doxycycline as PREP was associated with a decrease in the rate of any STI.
The use of doxy-PEP might reduce the first STI, mainly C. trachomatis , if used within 72 hours after condomless sex. The use of doxy-PREP might also decrease the chance of any STI; however, only 1 study was evaluated.
细菌性性传播感染（STIs），特别是沙眼衣原体、淋病奈瑟菌和梅毒螺旋体感染，在全球范围内造成了重大负担。使用多西环素进行暴露前预防（PREP或多西环素 - PREP）或暴露后预防（PEP或多西环素 - PEP）可能作为预防措施有效，因为它对沙眼衣原体和梅毒螺旋体有效。
我们的目标是评估多西环素作为PREP或PEP预防细菌性性传播感染（沙眼衣原体、淋病奈瑟菌和梅毒螺旋体）的疗效。
对高危个体的随机临床试验进行系统评价和荟萃分析，以评估多西环素在预防细菌性性传播感染方面是否与PREP或PEP一样有效。检索了PubMed - MEDLINE（联机医学文献分析和检索系统）、Cohrane、科学电子图书馆在线（SciELO）以及拉丁美洲和加勒比卫生科学文献数据库（Literatura Latino - Americana e do Caribe em Ciências da Saúde - LILACS），查找截至2024年3月发表的随机临床试验。从已发表的报告中提取数据。跨试验汇总了风险比（HRs）和风险率（RRs）以及95%置信区间（CI）。
主要终点是细菌性性传播感染的任何发病率和个体性传播感染。
分析共纳入4项研究，其中3项评估多西环素 - PEP，1项评估多西环素 - PREP。在多西环素 - PEP组，共评估了1182名参与者。在多西环素 - PEP研究的汇总分析中，多西环素 - PEP组首次性传播感染的发病率较低（HR，0.538 [95% CI，0.337 - 0.859]；I² = 77%；P < 0.05）。关于个体感染，仅纳入2项研究。在多西环素 - PEP组，沙眼衣原体个体感染的发病率与对照组相比更低（RR，0.291 [95% CI，0.093 - 0.911]）（I² = 89%；P < 0.05）。由于仅1项研究评估了多西环素 - PREP，因此无法计算荟萃分析指标；然而，使用多西环素作为PREP与任何性传播感染率的降低相关。
如果在无保护性行为后72小时内使用多西环素 - PEP，可能会降低首次性传播感染，主要是沙眼衣原体感染。使用多西环素 - PREP也可能降低任何性传播感染的几率；然而，仅评估了1项研究。
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