Ron Bartels heard about it more than a year ago: doxyPEP, antibiotics that you can take after sex to reduce the risk of a sexually transmitted disease. The 36-year-old man from Utrecht had tested positive twice, “while I was not having a super active period”, and was done with it.
Bartels had received a course of the antibiotic doxycycline at home from his GP when he was treated for chlamydia. He took the pills with him to Australia, where he would travel for two months. “That made me feel safe.” During the trip he took them after having sex. He came back without an STD.
DoxyPEP is a “hot topic” within STD control, says Henry de Vries, professor of skin infections at Amsterdam UMC. “In other countries, doctors are already prescribing it.” The number of STDs is increasing in many countries, partly because condom use is declining. DoxyPEP seems to be a solution. Users must take two hundred milligrams of doxycycline, two small pills, within 72 hours after sex.
I only use doxyPEP if I think I have run a high risk, for example with multiple partners in one evening
The drug is effective: thanks to doxyPEP, the number of syphilis and chlamydia diagnoses drops by 70 to 90 percent, showed foreign to research the last years On. DoxyPEP becomes named as one of the reasons that the number of STDs in the US does not seem to be increasing after decades.
The method seems to be gaining popularity in the Netherlands. “I hear it around me more and more,” says Jörgen Moorlag (43), an HIV activist and university employee from Amsterdam. He started it himself in 2017. Richard Keldoulis (61), owner of fetish club Church in Amsterdam, thought doxyPEP was “weird and exaggerated” the first time he heard about it, but soon became “very useful”. He’s been using it for about two years now. “Only if I think I have run a lot of risk,” he says. “For example, with multiple partners in one evening.”
Reverse
There is a downside: healthcare providers are concerned about the influence of doxyPEP on the resistance of bacteria. The Netherlands has therefore always been cautious with antibiotics. Chlamydia and syphilis are not known as bacteria that easily become resistant, but gonorrhea is. Exactly the reason why doxyPEP works a lot less well against gonorrhea. “Doxycycline is a commonly used antibiotic by general practitioners,” says physician-microbiologist Alje van Dam of the Amsterdam UMC. “It is used against many skin and respiratory infections, such as pneumonia. DoxyPEP poses a risk for this.”
Questions are also being raised about the usefulness of combating chlamydia without complaints, especially among men. “Men never get long-term complications from chlamydia,” says infectious disease control doctor Hanna Bos of Soa Aids Nederland. “So why would you, as a man who has sex with men, take antibiotics?” That leaves syphilis, but that is much less common in the Netherlands than in the US, for example.
Because of all these ifs and buts, a specially established working group had difficulty formulating a national guideline on doxyPEP. After almost a year, the working group – with general practitioners, infectious disease specialists, the RIVM, Soa Aids Netherlands and representatives of the LGBTQ community – has decided to advise against doxyPEP, “because much is still unclear about the long-term effects,” they announced on Tuesday. “We must continue to invest in good information about condom use,” says Hanna Bos.
Doctors can make exceptions and prescribe doxyPEP to people who are already using it informally. “There are people who use it,” says Bos. “Then you want them to do it the right way and be well informed.”
Thailand
Richard Keldoulis buys his doxycycline in Thailand, where he visits regularly. “You go to a pharmacy there and they just give you the pills. No questions asked.” Jörgen Moorlag has ordered doxyPEP online several times and had it sent to a virtual PO box in the United Kingdom. “In the UK you can import medication for your own use.” He then had the pills forwarded to the Netherlands. He also knows that drug dealers nowadays “STI pills” (selling pills against STDs).
Moorlag is now prescribed it by his GP. Acquaintances now ask Moorlag which studies they should cite to convince their GP.
DoxyPEP is the first new STD control drug in decades, at a time when innovations in national STD control are desperately needed
The working group’s advice follows more flexible positions from other countries on doxyPEP. Details vary, but most countries believe it could be offered to the at-risk group: men and trans women who have sex with men and have recently had an STD. “DoxyPEP is the first new STD control drug in decades, at a time when innovations in national STD control are desperately needed,” wrote the American health service CDC last June.
Other countries sound more cautious. This allowed experts to enter Australia only agree on doxyPEP as a prevention strategy against syphilis, not against chlamydia and gonorrhea. In Germany Only people who are already taking the HIV prevention pill PrEP or have HIV are eligible, because they generally have a higher risk of other STDs. It United Kingdom does not recommend doxyPEP at all.
Can’t men just use a condom? “That is not my choice,” says Moorlag. “Doxy makes me feel calmer. It reduces stress.” A condom is indeed “the best and safest,” says Ron Bartels. “But in the heat of the moment that doesn’t always work. And sometimes others don’t want it. I’m fine with that. I don’t think: then no sex.”
Doctor Hanna Bos laughs at the condom question. “Finger pointing does not work for behavioral change,” she says. “You have to give people good information.”
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