Doxycycline prophylaxis for the prevention of sexually transmitted infections: A systematic review and meta-analysis of randomized controlled trials

• Published in: International journal of infectious diseases Vol. 147; p. 107186
• Main Authors: Szondy, István, Meznerics, Fanni Adél, Lőrincz, Kende, Kemény, Lajos Vince, Walter, Anna, Mohammed, Alzahra Ahmed, Hegyi, Péter, Kiss, Norbert, Bánvölgyi, András
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.10.2024; Elsevier
• Subjects: Anti-Bacterial Agents - therapeutic use; Bacterial STI; Chlamydia Infections - epidemiology; Chlamydia Infections - prevention & control; Doxycycline - therapeutic use; Doxycycline postexposure prophylaxis; Doxycycline pre-exposure prophylaxis; Doxycycline prophylaxis; Female; Gonorrhea - epidemiology; Gonorrhea - prevention & control; Homosexuality, Male; Humans; Incidence; Male; Meta-analysis; Post-Exposure Prophylaxis - methods; Pre-Exposure Prophylaxis - methods; Prevention; Randomized Controlled Trials as Topic; Sexually Transmitted Diseases - epidemiology; Sexually Transmitted Diseases - prevention & control; Sexually Transmitted Diseases, Bacterial - epidemiology; Sexually Transmitted Diseases, Bacterial - microbiology; Sexually Transmitted Diseases, Bacterial - prevention & control; Syphilis - epidemiology; Syphilis - prevention & control; Transgender Persons; RR; RCT; CDC; RoB; TGW; AMR; CI; MSM; STI; PrEP; Meta-analysis; Prevention; CGW; CAP; Bacterial STI; LGBTQ; Doxycycline pre-exposure prophylaxis; MG; PEP; Doxycycline prophylaxis; Doxycycline postexposure prophylaxis; TCN; WHO
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2024.107186

•Doxycycline prophylaxis is an effective tool for bacterial STI prevention.•200 mg doxycycline after sex significantly reduced the risk of chlamydia and syphilis.•No serious adverse events were reported with the use of doxycycline prophylaxis.•The emergence of new antimicrobial resistance has to be more thoroughly studied.•The use of doxycycline prophylaxis should be considered in high-risk populations. To investigate the effects of doxycycline pre- and post-exposure prophylaxis (doxy-PrEP/PEP) on bacterial sexually transmitted infections (STIs) by conducting a systematic review and meta-analysis. PubMed, Embase, and CENTRAL were searched for randomized controlled trials (RCTs), including ongoing studies published until November 7, 2023. Our primary endpoint was the incidence of bacterial STIs measured as the number of visits with an STI per total number of visits. Random-effects model was used to estimate pooled effect sizes. The study was registered with PROSPERO, CRD42023478486. We identified six eligible studies containing data from seven articles and four conference abstracts, enrolling men who have sex with men (MSM), transgender women (TGW), and cisgender women (CGW). The pooled analysis of 1,766 participants with 602 newly diagnosed STIs showed a 56% decrease in the overall STI incidence using doxy-PrEP/PEP (RR = 0.44; 95% CI: 0.30-0.65; I2 = 73%). For doxy-PEP, including MSM and TGW only, the RR observed for overall STI incidence was 0.40 (95% CI: 0.28-0.57; I² = 37%), 0.19 (95% CI: 0.08-0.44; I² = 39%) for chlamydia, 0.23 (0.14-0.36; I² = 0%) for syphilis and 0.55 (95% CI: 0.34-0.87; I² = 41%) for gonorrhea. No serious adverse events were reported in the studies. The certainty of evidence regarding the efficacy of doxy-PEP among MSM and TGW was graded as high. Doxy-PEP significantly reduces the number of new cases of chlamydia and syphilis and is potentially effective against gonorrhea, influenced by local resistance patterns. Thus, it is a promising tool in the prevention of bacterial STIs among MSM and TGW. [Display omitted]