In the heat of the moment, the risk of contracting an STI is likely not at the forefront of your thoughts. With PrEP becoming increasingly common in the gay community and many gay men feeling like we’re protected from HIV, our concern about other (treatable) STIs is typically quite low.
Even though we are acutely aware that STIs like chlamydia and gonorrhea are possibilities, a lot of gay men simply don’t like to use condoms.
For some people it’s a matter of comfort and pleasure, such as uncircumcised people or those taking SSRIs who have difficulty attaining orgasm while wearing a condom. For others, it’s a matter of kink or sexual preference to engage in bareback (unprotected) sex, with the act of insemination or swallowing semen being an integral part of the sexual experience.
Any time you have sex without a condom, your risk of contracting an STI goes up. We generally encourage engaging in safer sex, but acknowledge that it’s important to understand that “safer” can have different meanings for different populations and at different times.
There’s no shame in preferring bareback sex, anonymous sex, or frequent sex with multiple partners. When it comes to engaging in these practices safely, DoxyPEP may be the right solution for you.
What is DoxyPEP?
DoxyPEP, or doxycycline post-exposure prophylaxis, is a treatment regimen in which a person takes a dose of doxycycline within 24-72 hours of potential STI exposure to prevent infections from developing.
Key Concept: Post-Exposure Prophylaxis.
Post-Exposure Prophylaxis, or PEP, is a medical term that applies to more than just DoxyPEP. Post-Exposure Prophylaxis treatments are relevant to a variety of conditions, particularly things like HIV-exposure or pregnancy, in which patients are able to take medication after exposure to prevent infections, pregnancy, or other complications from developing. PEP interventions typically require being used very soon after exposure. The longer you wait for a PEP intervention, the less likely it is to be successful as many PEP treatments will not work if the medical condition has already developed.
The current guidelines for DoxyPEP treatment is to take “200 mg of doxycycline within 72 hours after condomless sex (oral and/or anal),” but it’s important to acknowledge that this is still a fairly new approach to treating and preventing STIs.
Most clinical studies on using doxycycline as post-exposure prophylaxis have only recently been published (2022 and 2023), and while the CDC has “issued a permissive response” to studies showing the efficacy of the treatment, as of May 2023, they have not provided official clinical guidance.
When taking doxycycline according to the appropriate protocol following unprotected sex, research shows a 65% reduction in the development of bacterial infections– chlamydia, gonorrhea, and syphilis.
What is Doxycycline?
Doxycycline is an antibiotic. It is a drug that belongs to the tetracycline family of antibiotics.
As Mollie C. Shutter and Hossein Akhondi document in an article in the National Library of Medicine, “Tetracyclines (tetracycline, doxycycline, minocycline, tigecycline) are a class of medication used to manage and treat various bacterial infections. Tetracyclines classify as protein synthesis inhibitor antibiotics and are considered to be broad-spectrum.”
What this means is that tetracyclines such as doxycycline work across a wide variety of bacterial infections. They can be used to treat a variety of conditions, including rosacea, acne, respiratory conditions, and STIs.
Bacterial Infections vs Viral Infections
When it comes to taking DoxyPEP to prevent STIs, it’s important to recognize that because doxycycline is an antibiotic, it is only effective in preventing bacterial infections and not viral infections.
Common STIs like chlamydia, gonorrhea, and syphilis are all bacterial in origin, which means that they are caused by bacteria establishing a colony and replicating within your body.
Other STIs are caused by viruses, such as HIV, herpes, and HPV. Bacteria and viruses are entirely separate classes of organisms and function very differently once they are established within your body. Several viral infections are considered “incurable” currently, meaning that even though they can be suppressed and managed with medication, you cannot “be cured” of them entirely.
Because of the different mechanics between viral and bacterial infections, it’s important to acknowledge that doxyPEP is not a get-out-of-jail-free card for all types of STIs. It’s important to take other precautions if you engage in unprotected or anonymous sex, including oral sex.
Other Preventative Treatments to Consider Alongside DoxyPEP
Because DoxyPEP can only reduce your likelihood of contracting a bacterial infection, other treatments may make sense for you.
- PrEP, most commonly Truvada, Descovy, Apretude, and their generic versions, is used to prevent HIV infections. When taken as prescribed, “PrEP reduces the risk of getting HIV from sex by about 99%.” Your primary care provider can prescribe PrEP, or you can use a service like Nurx to receive a prescription.
- Vaccinations for HPV and Hepatitis. Vaccinating against viruses is one of the best ways to prevent them from becoming established or developing complications. This is true of STI-causing viruses and non-STI-causing viruses alike. Vaccinations for HPV and Hepatitis can be attained easily by contacting your primary care provider or local department of health branch.
Why is STI Prevention Important?
According to the CDC, half of all sexually active people will contract an STD by age 25. More than 2.5 million cases of chlamydia, gonorrhea, and syphilis were reported in 2021.
Even if such infections are asymptomatic, they can result in long-term health complications, such as increasing your risk of certain types of cancers or infertility. Plus, there’s a sense of shame and community rejection if you spread an STI due to the stigma around such illnesses and the outdated “clean vs dirty” mentality that’s still common in the queer community.
A byproduct of the shame and stigma associated with STIs and sexual health testing is that people are often reluctant to get tested or communicate with sexual partners about their testing history and status, which contributes to the ongoing spread of STIs.
According to the US Department of Health and Human Services, “If left untreated, STIs can lead to severe health complications, including pelvic inflammatory disease (PID), increased risk of getting HIV, certain cancers, and even infertility.”
In short, STIs can have a wide variety of negative effects on your health, including long-term, complicated health issues.
The best starting point for having a satisfying sex life is to have a healthy one, understanding not only your likes and dislikes but also your wellbeing and medical needs.
What are STI Symptoms Like?
When symptomatic, STIs can cause significant discomfort, discharge, fever, swelling of the testicles and inflammation of the genitals, sore throat, or swollen lymph nodes, among other symptoms.
The symptoms you can experience depend upon the type and severity of the infection, as well as other individual factors, such as your HIV status or other medical conditions that affect your immune system.
Are There Risks or Side Effects to Taking DoxyPEP?
All medications come with potential side effects. Doxycycline is no different.
With DoxyPEP, there are two warnings I want to callout up front since they’re a bit atypical for what people usually expect with medications:
- Doxycycline can increase your sensitivity to sunlight, so it is is very important to use sunscreen while taking doxycycline.
- Avoid drinking alcohol while taking doxycycline as it can reduce the effectiveness of the medication, meaning that even if you take your DoxyPEP after exposure and then go to have drinks, you may be undermining your efforts to prevent infection.
Aside from that, the more common side effects of doxycycline include:
- stomach upset or vomiting
- oral or vaginal thrush
- rash or itching
- nail changes
- mild irritation of the oesophagus (food pipe)
- taste loss
- ringing or other persistent noise in the ears
Serious side effects of doxycycline, which may need urgent medical attention, include:
- increased pressure in the brain (headache, blurred vision, vomiting)
- severe blisters and bleeding in the lips, eyes, mouth, nose and genitals
- severe skin reactions
- difficulty or pain in swallowing
- dizziness
- fast heart rate
- allergic reactions, including anaphylaxis
As always, it’s important to callout that side effects are not guaranteed- you may not experience any negative effects while taking doxycycline, but it’s important to speak to your physician if you do. Dr. Blen Tesfu reminds us, “These side effects can vary in severity and may not affect everyone who takes the medication. A healthcare professional can assess the individual’s medical history and any contraindications to determine the suitability and potential risks associated with DoxyPEP.”
How to Know if DoxyPEP is Right For You?
You know your sexual habits and preferences more than anybody else. If you frequently have unprotected sex or want to have more unprotected sex, then you should talk to your doctor about starting DoxyPEP as a treatment.
In more explicit terms, if you’ve ever thought to yourself that you want to be a “no loads refused cumdump,” have a breeding kink, or engage in cruising (including at saunas and bathhouses), but are worried about STIs, then DoxyPEP is probably a good option to explore.
That said, Dr. Tesfu encourages patients to remember that DoxyPEP is not a perfect solution. She writes,
While DoxyPEP may offer some level of protection, it is not a foolproof method and should not be considered a substitute for safer sexual practices, such as condom use. Condoms are still the most effective way to prevent the transmission of STIs and should be used consistently and correctly during sexual activity, especially with anonymous partners where the sexual history and STI status are unknown.
Dr. Blen Tesfu, Welzo.com
How to Talk to Your Doctor About DoxyPEP
The most difficult part of DoxyPEP may be talking to your doctor about it and getting them on board with prescribing it. For many of us, talking about our sexual health, even with our physician, can be difficult. That’s especially true if you grew up in an environment where you learned to think of sex as something private, dirty, or shameful.
So, keep this in mind when you go to your doctor:
- Doctors are bound by HIPPA to keep your medical information private. Your doctor isn’t going to be gossiping about you wanting to take DoxyPEP.
- Your doctor is probably going to advise condoms as the better line of defense. Stand your ground and reiterate to your doctor that you are aware of the efficacy of condoms and know how to use condoms correctly, but you have preferences or other reasons for engaging in sex without condoms.
- Your doctor may not be aware of DoxyPEP as a treatment regimen. As mentioned earlier, it is an emerging treatment and the CDC has not issued clinical guidances yet. Have the following links ready on your phone to share with your doctor:
- The San Francisco City Clinic’s Guidance on DoxyPEP. Even if you’re not in San Francisco, being able to see how other providers use DoxyPEP can help your doctor.
- The CDC Response to DoxyPEP Trial Data
- If your doctor still insists on condoms or celibacy (the latter is a huge red flag), or does not seem well-versed in queer-specific health concerns, consider seeking out physicians whose scope of practice is explicitly LGBTQ-informed. Websites like OutCare and the LGBTQ+ Healthcare Directory can help you find providers in your area.
Key Takeaways
Dr. Tesfu sums up her guidances on DoxyPep by stating that “It is crucial to emphasize the importance of open communication and informed decision-making regarding sexual health.” She goes on to encourage people to “discuss their concerns, preferences, and sexual practices with a healthcare professional, who can provide comprehensive guidance and support, including counseling on safe sex practices, regular STI testing,” which work in conjunction with safer sex practices to reduce the spread of STIs.
That said, if you do decide to discuss the use of DoxyPEP with a healthcare provider, go into the conversation informed. Remember:
- DoxyPEP cannot prevent viral infections. It only works to prevent bacterial infections, such as chlamydia and gonnhorea.
- DoxyPEP does not have a 100% efficacy rate. It is still possible to get a bacterial infection while using DoxyPEP as prescribed.
- There are side effects and possible medication interactions that your medical care provider should evaluate.
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