Bird James, Alawyia Basil, Spernovasilis Nikolaos, Alon-Ellenbogen Danny
Department of Basic and Clinical Sciences, University of Nicosia, Nicosia 2417, Cyprus.
Department of Infectious Diseases, German Medical Institute, Limassol 4108, Cyprus.
Antibiotics (Basel). 2024 Dec 5;13(12):1183. doi: 10.3390/antibiotics13121183.
Over the past two decades, the global incidence of sexually transmitted infections (STIs) such as gonorrhea, chlamydia, and syphilis have increased significantly, particularly among cisgender men who have sex with men (MSM) and transgender women (TGW). This rise in STIs has spurred interest in new preventive measures, including doxycycline post-exposure prophylaxis (DoxyPEP). Clinical trials in the United States and France have demonstrated the effectiveness of DoxyPEP in reducing both chlamydia and syphilis incidence among MSM and TGW; although, its efficacy against gonorrhea remains limited, and it was further found to be ineffective among cisgender women in Kenya. Due to the promising results, the CDC and the German STI Society have incorporated DoxyPEP into their guidelines for specific high-risk groups. However, the broader implementation of DoxyPEP presents several challenges and ethical concerns. Key issues involve the potential development of antimicrobial resistance, particularly among common STI pathogens like , , and , as well as other bacteria such as and . Additionally, questions concerning equitable healthcare access, the potential impact on adherence to safer sex practices, and broader public health implications warrant careful consideration. Addressing these challenges necessitates a careful balance between the benefits and risks of DoxyPEP, as well as the implementation of strategies to mitigate negative outcomes while maximizing the impact on public health. Lastly, future research should explore the integration of DoxyPEP with other preventive strategies, such as vaccines, to enhance its effectiveness and reduce the global burden of STIs.
在过去二十年中，淋病、衣原体感染和梅毒等性传播感染（STIs）的全球发病率显著上升，尤其是在与男性发生性关系的顺性别男性（MSM）和跨性别女性（TGW）中。性传播感染的这种上升引发了人们对新预防措施的兴趣，包括多西环素暴露后预防（DoxyPEP）。美国和法国的临床试验证明了DoxyPEP在降低男男性行为者和跨性别女性中衣原体和梅毒发病率方面的有效性；尽管如此，其对淋病的疗效仍然有限，并且进一步发现它在肯尼亚的顺性别女性中无效。由于取得了有前景的结果，美国疾病控制与预防中心（CDC）和德国性传播感染协会已将DoxyPEP纳入其针对特定高危人群的指南中。然而，DoxyPEP的更广泛实施存在若干挑战和伦理问题。关键问题包括抗菌药物耐药性的潜在发展，尤其是在常见的性传播感染病原体如[此处原文未明确病原体名称]、[此处原文未明确病原体名称]和[此处原文未明确病原体名称]以及其他细菌如[此处原文未明确细菌名称]和[此处原文未明确细菌名称]中。此外，有关公平获得医疗保健、对坚持更安全性行为的潜在影响以及更广泛的公共卫生影响等问题值得仔细考虑。应对这些挑战需要在DoxyPEP的益处和风险之间谨慎权衡，以及实施策略以减轻负面结果，同时最大限度地提高对公共卫生的影响。最后，未来的研究应探索将DoxyPEP与其他预防策略（如疫苗）相结合，以提高其有效性并减轻性传播感染的全球负担。
