{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:03:01Z","timestamp":1792609381781,"version":"4.5.0"},"reference-count":19,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"\n Importance<\/jats:title>\n Doxycycline postexposure prophylaxis (doxyPEP) has been shown to decrease the incidence of bacterial sexually transmitted infections (STIs) among people assigned male sex at birth in clinical trials, but data from clinical practice are limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To describe early uptake of doxyPEP and evaluate changes in STI incidence following doxyPEP initiation.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study of adults (aged \u226518 years) dispensed HIV preexposure prophylaxis (PrEP) at Kaiser Permanente Northern California during November 1, 2022, to December 31, 2023, examined electronic health record data to compare HIV PrEP users dispensed and not dispensed doxyPEP and rates of bacterial STIs before and after starting doxyPEP. Individuals were followed up from their first recorded STI test on or after November 1, 2020, until December 31, 2023, or discontinuation of health plan membership.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Pharmacy dispensing data were used to define doxyPEP recipients.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Demographic and clinical characteristics were compared between individuals dispensed and not dispensed doxyPEP. Primary outcomes were incident chlamydia, gonorrhea, or infectious syphilis measured as quarterly STI positivity (proportion of individuals testing positive at least once per quarter). Among doxyPEP recipients, rate ratios (RRs) compared mean quarterly STI positivity from 24 months before to 12 months after starting doxyPEP. In an exploratory analysis, STI trends were evaluated for the full cohort, stratified by receipt of doxyPEP.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 11\u202f551 HIV PrEP users (mean [SD] age, 39.9 [12.1] years; 95.1% male), 2253 (19.5%) were dispensed doxyPEP, of whom 2228 (98.9%) were male and 1096 (48.6%) had an STI in the year before starting doxyPEP. Compared with individuals not dispensed doxyPEP, doxyPEP recipients were older (mean [SD] age, 40.4 [10.8] vs 39.8 [12.4] years;\n P<\/jats:italic>\n \u2009=\u2009.04) and had used HIV PrEP longer (mean [SD], 4.2 [2.8] vs 3.4 [2.6] years;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), and a higher proportion were commercially insured (2091 [92.8%] vs 8270 [88.9%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Among doxyPEP recipients, quarterly chlamydia positivity decreased from 9.6% (95% CI, 9.0%-10.3%) before starting doxyPEP to 2.0% (95% CI, 1.5%-2.6%) after starting doxyPEP (RR, 0.21; 95% CI, 0.16-0.27;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), with significant declines for each anatomic site of infection. Quarterly gonorrhea positivity decreased from 10.2% (95% CI, 9.6%-10.9%) before starting doxyPEP to 9.0% (95% CI, 8.0%-10.1%) after starting doxyPEP (RR, 0.88; 95% CI, 0.77-1.00;\n P<\/jats:italic>\n \u2009=\u2009.048); site-specific declines were significant for rectal (RR, 0.81; 95% CI, 0.67-0.97;\n P<\/jats:italic>\n \u2009=\u2009.02) and urethral (RR, 0.56; 95% CI, 0.40-0.79;\n P<\/jats:italic>\n \u2009=\u2009.001) gonorrhea, but not pharyngeal gonorrhea. Quarterly syphilis positivity decreased from 1.7% (95% CI, 1.4%-1.9%) before starting doxyPEP to 0.3% (95% CI, 0.2%-0.6%) after starting doxyPEP (RR, 0.20; 95% CI, 0.11-0.37;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Positivity for STIs remained stable in individuals not dispensed doxyPEP.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This study found that receipt of doxyPEP was associated with substantial declines in chlamydia and syphilis incidence and modest declines in urethral and rectal gonorrhea incidence among individuals using HIV PrEP. These findings suggest that doxyPEP may offer substantial benefits for reducing population-level STI transmission with broader implementation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamainternmed.2024.7186","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T11:01:11Z","timestamp":1736161271000},"page":"273","source":"Crossref","is-referenced-by-count":61,"title":["Doxycycline Postexposure Prophylaxis and Bacterial Sexually Transmitted Infections Among Individuals Using HIV Preexposure Prophylaxis"],"prefix":"10.1001","volume":"185","author":[{"given":"Michael W.","family":"Traeger","sequence":"first","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts"},{"name":"Burnet Institute, Melbourne, Australia"},{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy A.","family":"Leyden","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Pleasanton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan E.","family":"Volk","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Kaiser Permanente San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Silverberg","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Pleasanton"},{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"},{"name":"Departments of Epidemiology andBiostatistics, University of California, San Francisco"},{"name":"Department of Medicine, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Horberg","sequence":"additional","affiliation":[{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"},{"name":"Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Medical Group, Washington, District of Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teaniese L.","family":"Davis","sequence":"additional","affiliation":[{"name":"Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth H.","family":"Mayer","sequence":"additional","affiliation":[{"name":"The Fenway Institute, Fenway Health, Boston, Massachusetts"},{"name":"Harvard Medical School, Harvard University, Boston, Massachusetts"},{"name":"Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas S.","family":"Krakower","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts"},{"name":"The Fenway Institute, Fenway Health, Boston, Massachusetts"},{"name":"Harvard Medical School, Harvard University, Boston, Massachusetts"},{"name":"Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica G.","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts"},{"name":"Harvard Medical School, Harvard University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel M.","family":"Jenness","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia L.","family":"Marcus","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts"},{"name":"The Fenway Institute, Fenway Health, Boston, Massachusetts"},{"name":"Harvard Medical School, Harvard University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"3","key":"ioi240087r1","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1016\/S1473-3099(17)30725-9","article-title":"Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial.","volume":"18","author":"Molina","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"14","key":"ioi240087r2","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1056\/NEJMoa2211934","article-title":"Postexposure doxycycline to prevent bacterial sexually transmitted infections.","volume":"388","author":"Luetkemeyer","year":"2023","journal-title":"N Engl J 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population: implications for generalizability of research.","volume":"27","author":"Davis","year":"2023","journal-title":"Perm J"},{"issue":"5","key":"ioi240087r7","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1097\/QAI.0000000000001129","article-title":"Preexposure prophylaxis for HIV prevention in a large integrated health care system: adherence, renal safety, and discontinuation.","volume":"73","author":"Marcus","year":"2016","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"ioi240087r8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7301a1","article-title":"CDC laboratory recommendations for syphilis testing, United States, 2024.","volume":"73","author":"Papp","year":"2024","journal-title":"MMWR Recomm Rep"},{"issue":"11","key":"ioi240087r11","doi-asserted-by":"publisher","first-page":"e46","DOI":"10.1097\/OLQ.0000000000001996","article-title":"Trends in sexually transmitted infections associated with the doxycycline post-exposure prophylaxis guidelines in San Francisco.","volume":"51","author":"Liu","year":"2024","journal-title":"Sex Transm Dis"},{"issue":"7","key":"ioi240087r13","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.1093\/jac\/dkad129","article-title":"Important considerations regarding the widespread use of doxycycline chemoprophylaxis against sexually transmitted infections.","volume":"78","author":"Kong","year":"2023","journal-title":"J Antimicrob Chemother"},{"key":"ioi240087r14","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae062","article-title":"Filling in the gaps: updates on doxycycline prophylaxis for bacterial sexually transmitted infections.","author":"Hazra","year":"2024","journal-title":"Clin Infect Dis"},{"issue":"5","key":"ioi240087r15","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1093\/jac\/dky548","article-title":"Pharmacokinetic considerations regarding the treatment of bacterial sexually transmitted infections with azithromycin: a review.","volume":"74","author":"Kong","year":"2019","journal-title":"J Antimicrob Chemother"},{"issue":"10","key":"ioi240087r16","doi-asserted-by":"publisher","first-page":"656","DOI":"10.3390\/antibiotics9100656","article-title":"Exploration of the Neisseria resistome reveals resistance mechanisms in commensals that may be acquired by N. gonorrhoeae through horizontal gene transfer.","volume":"9","author":"Fiore","year":"2020","journal-title":"Antibiotics (Basel)"},{"issue":"13","key":"ioi240087r17","doi-asserted-by":"publisher","first-page":"1951","DOI":"10.1097\/QAD.0000000000002618","article-title":"A taxonomy of pragmatic measures of HIV preexposure prophylaxis use.","volume":"34","author":"Pyra","year":"2020","journal-title":"AIDS"},{"issue":"10","key":"ioi240087r18","doi-asserted-by":"publisher","first-page":"1601","DOI":"10.1093\/cid\/civ778","article-title":"No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting.","volume":"61","author":"Volk","year":"2015","journal-title":"Clin Infect Dis"},{"issue":"8","key":"ioi240087r19","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1093\/aje\/kwv254","article-title":"Using big data to emulate a target trial when a randomized trial is not available.","volume":"183","author":"Hern\u00e1n","year":"2016","journal-title":"Am J Epidemiol"},{"key":"ioi240087r10","author":"Scott","year":"2024"},{"key":"ioi240087r12","first-page":"763","article-title":"Use of doxycycline and other antibiotics as bacterial sexually transmitted infection prophylaxis in a US sample of primarily gay and bisexual men.","volume-title":"Sex Transm Dis","author":"Traeger","year":"2024"},{"key":"ioi240087r4","unstructured":"Health update: doxycycline post-exposure prophylaxis reduces incidence of sexually transmitted infections. San Francisco Department of Public Health. Published October 20, 2022. Accessed March 29, 2024. https:\/\/www.sfcdcp.org\/wp-content\/uploads\/2022\/10\/Health-Update-Doxycycline-Post-Exposure-Prophylaxis-Reduces-Incidence-of-Sexually-Transmitted-Infections-SFDPH-FINAL-10.20.2022.pdf"},{"key":"ioi240087r9","unstructured":"Sexually transmitted disease surveillance 2021. Centers for Disease Control and Prevention. Accessed August 20, 2024. https:\/\/www.cdc.gov\/std\/statistics\/2022\/2021-STD-Surveillance-Report-PDF_ARCHIVED-2-16-24.pdf"}],"container-title":["JAMA Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/articlepdf\/2828994\/jamainternal_traeger_2025_oi_240087_1740771781.37433.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T11:05:18Z","timestamp":1740999918000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2828994"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,1]]},"references-count":19,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamainternmed.2024.7186","relation":{},"ISSN":["2168-6106"],"issn-type":[{"value":"2168-6106","type":"print"}],"subject":[],"published":{"date-parts":[[2025,3,1]]}}}