Experts warn against DoxyPEP STI prevention over antibiotic resistance
Dutch health experts have formally advised against the use of doxycycline post-exposure prophylaxis (doxyPEP), an antibiotic regimen intended to prevent sexually transmitted infections (STIs), citing concerns about antibiotic resistance and long-term health impacts. Experts continue to emphasize condom use as the most effective and safest method of STI prevention. The recommendation, announced Tuesday, follows months of deliberation by a working group that included general practitioners, infectious disease specialists, the RIVM, Soa Aids Nederland, and LGBTQ+ community representatives.
DoxyPEP involves taking 200 milligrams of doxycycline—two small pills—within 72 hours after sexual activity. The practice has gained popularity among certain groups, particularly men who have sex with men (MSM), due to its reported effectiveness in reducing syphilis and chlamydia diagnoses by 70 to 90 percent, according to international studies.
Ron Bartels, a 36-year-old from Utrecht, began using doxycycline for STI prevention over a year ago after two positive STI tests. "I wasn’t in a particularly active phase, but I was done with it," Bartels said. During a two-month trip to Australia, he brought leftover doxycycline from a previous chlamydia treatment. "It gave me a sense of security," he said. He returned home without any STI diagnoses.
Others, like Richard Keldoulis, owner of fetish club Church in Amsterdam, also use doxyPEP selectively. "I only take it when I think I’ve been at significant risk, like with multiple partners in one evening," Keldoulis said.
HIV activist Jörgen Moorlag, 43, started using doxyPEP in 2017 and has observed its growing adoption within his community. "I hear about it more and more," he said. Moorlag initially purchased doxycycline online and had it delivered to a virtual mailbox in the UK, where importing medication for personal use is permitted.
Health professionals remain wary of doxyPEP’s broader implications. While the regimen appears effective against syphilis and chlamydia, it is less so for gonorrhea, which is already showing signs of antibiotic resistance globally. Alje van Dam, a microbiologist at Amsterdam UMC, noted, "Doxycycline is widely used for other infections, like pneumonia. DoxyPEP could increase the risk of resistance, jeopardizing its effectiveness."
Another concern is the limited benefit of treating asymptomatic chlamydia infections in men. "Men rarely face long-term complications from chlamydia," said Hanna Bos, an infectious disease specialist at Soa Aids Nederland. "So why would men who have sex with men take antibiotics for it?"
After nearly a year of discussions, the Dutch working group decided against endorsing doxyPEP for widespread use due to the lack of data on long-term effects. However, the group acknowledged that exceptions might be made for individuals already using doxyPEP informally. "We want to ensure they use it correctly and with proper guidance," Bos said.
The Netherlands’ cautious stance contrasts with policies in other countries. The U.S. Centers for Disease Control and Prevention (CDC) recently called doxyPEP a "much-needed innovation in STI prevention," recommending its use for MSM and transgender women with recent STI diagnoses. In Australia, experts endorsed doxyPEP only for syphilis prevention. Germany restricts the regimen to individuals already on PrEP or living with HIV, while the UK has fully discouraged its use.
In the Netherlands, doxyPEP is not formally prescribed, leading some users to seek alternatives. Keldoulis purchases doxycycline during trips to Thailand, where the antibiotic is sold without prescriptions. "You just go to a pharmacy and they hand over the pills. No questions asked," he said.
Meanwhile, Moorlag has convinced his general practitioner to prescribe doxyPEP. "People ask me which studies they should reference to persuade their doctors," he said.
Bos, reflecting on behavioral challenges, said, "Pointing fingers doesn’t work for changing behavior. You have to provide people with accurate information."
