Doctors are turning to post-sex antibiotics to fight the rise of syphilis

Doctors are turning to post-sex antibiotics to fight the rise of syphilis

Faced with an alarming rise in syphilis cases, a group of American doctors recently implemented an experimental strategy: asking high-risk patients to take a single pill of a common antibiotic after unprotected sex to try to prevent infection.

San Francisco has become the first US public health authority to issue formal guidelines recommending the strategy following the publication of two studies showing that doxycycline can slash transmission rates of potentially life-threatening diseases.

In July, a US study found that taking a single dose of doxycycline within 72 hours of unprotected sex reduced the risk of contracting syphilis, chlamydia and gonorrhea by more than 60 percent among people at high risk for sexually transmitted infections. .

This week, a French study evaluating the use of doxycycline and the meningococcal B vaccine to prevent bacterial STDs, in combination and separately, reported similar results. The trials raised hopes that antibiotics could become a powerful tool in the fight against disease.

“It’s a big step forward in the fight against sexually transmitted diseases,” said Yazdan Yazdanpanah, director of the French agency ANRS, which funded the study.

He said the positive results of the trial should lead to changes in global health recommendations for the prevention of syphilis, chlamydia and gonorrhea.

Sexual health doctors said the introduction of doxycycline was needed because of rising rates of sexually transmitted infections, prompting US authorities to warn of a “sexual health crisis”.

The number of syphilis cases in the US jumped by more than a quarter last year to 171,000, the highest level in more than 70 years, according to the Centers for Disease Control and Prevention.

But the strategy has raised concerns among some experts, who argue that prescribing doxycycline to prevent bacterial STDs could increase resistance to the antibiotic, which is also used to prevent malaria and treat other types of infections.

“There is certainly a need to have more options for preventing bacterial sexually transmitted infections among high-risk groups, and the data from the syphilis and chlamydia prevention study are quite compelling,” said Professor Cindy Liu, chief medical officer at the Antibiotic Resistance Action Center at George Washington University. for the public. health school.

“But we have to address the concern that this could cause an increase in doxycycline-resistant MRSA and undermine the usefulness of the antibiotic,” she said, referring to the infection caused by staph bacteria. “I think we need more data on this, as well as the change in antibiotic-resistant bacterial STIs.”

Liu said the San Francisco government’s guidance to doctors about doxycycline should put more emphasis on the need to regularly test patients for STIs. The study found that doxycycline is less effective in preventing gonorrhea, which is on the verge of becoming incurable and can increase patients’ risk of HIV infection.

Gonorrhea, which causes pain and inflammation, has accumulated resistance to seven antibiotics since treatments became widely available in the 1930s. One of the only courses of treatment is an injectable antibiotic called ceftriaxone.

Some experts are also concerned that using doxycycline to prevent STDs could undermine the use of condoms, which most doctors agree should remain the primary means of controlling the spread of sexually transmitted diseases.

But others say condom use has fallen sharply among high-risk groups, such as men who have sex with men. This is largely due to the introduction of PrEP, a once-daily pill that protects people from HIV infection. This underscores the urgent need for new tools to stop the spread of STIs, they say.

“People are already using doxycycline off-label — it’s not just in these studies, mainly because some patients really need this intervention,” said Troy Grennan, an associate professor in the department of infectious diseases at the University of British Columbia.

He said it’s important to continue studying antimicrobial resistance and send the message that doxycycline should be a targeted intervention for a small number of people. “This is not a one-size-fits-all STD prevention strategy for everyone,” said Grennan, who has prescribed doxycycline to some high-risk patients.

Researchers have been studying doxycycline’s effect on sexually transmitted diseases for several years, but preliminary results from a US study presented in July, which included just over 500 people in high-risk groups, showed that prompted San Francisco’s public health authorities are issuing new guidelines.

The treatment was 88 percent effective in preventing chlamydia infection in HIV-negative people and 87 percent in syphilis, although its ability to stop gonorrhea was a more modest 55 percent, according to the study, which has not yet been verified. .

The trial found that a fifth of people diagnosed with gonorrhea were resistant to doxycycline, which increased over the course of the study. There was no evidence of resistance in syphilis or chlamydia.

Annie Luetkemeyer, director of medicine and infectious diseases at the University of California, San Francisco and the study’s principal investigator, said more surveillance data from communities where doxycycline is prescribed is needed to determine whether the strategy will increase antibiotic resistance.

“We are revaluing influence. . . on bacteria such as Staph aureus, commensal Neisseria (found in the throat) and gut bacteria,” she said.

The CDC said it was “excited” by the initial findings of the UCSF study, which was funded by the National Institutes of Health. But Leandro Mena, director of the CDC’s Division of Sexually Transmitted Disease Prevention, said the agency wants to review the full data and consider the issue of antimicrobial resistance before issuing official guidance to doctors.

Mena said that the agency was also encouraged recently study which suggested that the meningitis vaccine showed promise in reducing the risk of gonorrhea infections by as much as 40 percent. Even a partially effective vaccine could have a significant effect in reducing transmission rates, he said.

“If only we could have a vaccine that could effectively reduce the risk of getting these infections. You know that would be the Holy Grail,” added Mena.

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