{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T02:22:40Z","timestamp":1780626160149,"version":"3.54.1"},"reference-count":22,"publisher":"CSIRO Publishing","issue":"4","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":50,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,29]]},"abstract":"<jats:title\/>\n                  <jats:p>In September 2023, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine recommended doxycycline pre-exposure prophylaxis to prevent STIs in gay, bisexual and other men who have sex with men. However, expanding antibiotic use carries the risk of propagating antimicrobial resistance among target STIs and non-target pathogens, prompting some experts to advocate withholding doxycycline pre-exposure prophylaxis until further research is done. Thus, the use of doxycycline pre-exposure prophylaxis is a question of whether the risk of antimicrobial resistance to the population is justified by the health benefits to gay, bisexual and other men who have sex with men. Here, we outline the public health ethics cases for and against this strategy.<\/jats:p>","DOI":"10.1071\/sh24008","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T06:22:35Z","timestamp":1753424555000},"source":"Crossref","is-referenced-by-count":3,"title":["A public health ethics analysis of Doxy-PEP: arguments for and against \u2013 the \u2018no\u2019 case"],"prefix":"10.1071","volume":"22","author":[{"given":"Shreyas","family":"Iyer","sequence":"first","affiliation":[{"name":"AUNSW School of Population Health, Nepean Hospital, Penrith, NSW, Australia. Email: Shreyas.Iyer@health.nsw.gov.au"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0657-9610","authenticated-orcid":true,"given":"Bridget","family":"Haire","sequence":"additional","affiliation":[{"name":"BKirby Institute, School of Population Health, UNSW Sydney, Kensington, NSW, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"67","published-online":{"date-parts":[[2025,7,22]]},"reference":[{"issue":"10325","key":"2025102617234889700_R1","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis.","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"issue":"6","key":"2025102617234889700_R2","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1093\/cid\/ciz866","article-title":"Doxycycline prophylaxis for bacterial sexually transmitted infections.","volume":"70","author":"Grant","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"14","key":"2025102617234889700_R3","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 Med"},{"issue":"3","key":"2025102617234889700_R4","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1093\/jac\/dkx420","article-title":"Doxycycline in the management of sexually transmitted infections.","volume":"73","author":"Peyriere","year":"2018","journal-title":"J Antimicrob Chemother"},{"key":"2025102617234889700_R5","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad488","article-title":"Potential impact of doxycycline post-exposure prophylaxis prescribing strategies on incidence of bacterial sexually transmitted infections.","author":"Traeger","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2025102617234889700_R6","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1177\/09564624231190108","article-title":"Doxycycline post exposure prophylaxis could select for cross-resistance to other antimicrobials in various pathogens: an in silico analysis.","volume":"34","author":"Gestels","year":"2023","journal-title":"Int J STD AIDS"},{"key":"2025102617234889700_R7","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2023.1208014","article-title":"Doxycycline PEP can induce doxycycline resistance in Klebsiella pneumoniae in a Galleria mellonella model of PEP.","volume":"14","author":"Kenyon","year":"2023","journal-title":"Front Microbiol"},{"issue":"7","key":"2025102617234889700_R8","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"},{"issue":"11","key":"2025102617234889700_R9","doi-asserted-by":"publisher","first-page":"100926","DOI":"10.1016\/S2666-5247(24)00168-X","article-title":"Effects of doxycycline post-exposure prophylaxis for prevention of sexually transmitted infections on gonorrhoea prevalence and antimicrobial resistance among men who have sex with men in the USA: a modelling study.","volume":"5","author":"Reichert","year":"2024","journal-title":"Lancet Microbe"},{"issue":"8","key":"2025102617234889700_R10","doi-asserted-by":"publisher","first-page":"e268","DOI":"10.1016\/S1473-3099(23)00359-6","article-title":"Selection of Neisseria gonorrhoeae ceftriaxone resistance using doxycycline post-exposure prophylaxis.","volume":"23","author":"Whiley","year":"2023","journal-title":"Lancet Infect Dis"},{"issue":"11","key":"2025102617234889700_R11","doi-asserted-by":"publisher","first-page":"1776","DOI":"10.2105\/AJPH.91.11.1776","article-title":"An ethics framework for public health.","volume":"91","author":"Kass","year":"2001","journal-title":"Am J Public Health"},{"issue":"1","key":"2025102617234889700_R12","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1093\/jac\/dkr425","article-title":"Ethical dilemmas in antibiotic treatment.","volume":"67","author":"Leibovici","year":"2012","journal-title":"J Antimicrob Chemother"},{"key":"2025102617234889700_R13","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1097\/OLQ.0000000000001907","article-title":"Ethical considerations in implementing doxycycline postexposure prophylaxis for the prevention of bacterial sexually transmitted infections.","volume":"51","author":"Sugarman","year":"2024","journal-title":"Sex Transm Dis"},{"issue":"1","key":"2025102617234889700_R14","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1038\/s41591-024-03274-2","article-title":"Impact of doxycycline post-exposure prophylaxis for sexually transmitted infections on the gut microbiome and antimicrobial resistome.","volume":"31","author":"Chu","year":"2025","journal-title":"Nat Med"},{"key":"2025102617234889700_R15","unstructured":"Molina J-M, Bercot B, Assoumou L. HIV and STI prevention: new tools and approaches (Abstract number 119). Conference on Retroviruses and Opportunistic Infections (CROI); 19\u201322 February 2023; Seattle, Washington; 2023."},{"key":"2025102617234889700_R16","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1093\/infdis\/jiae160","article-title":"What if we had a vaccine that prevents Neisseria gonorrhoeae? inspiration, assumptions, and aspirations.","volume":"231","author":"Cohen","year":"2025","journal-title":"J Infect Dis"},{"issue":"1","key":"2025102617234889700_R17","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-022-07843-z","article-title":"Why do men who have sex with men practice condomless sex? A systematic review and meta-synthesis.","volume":"22","author":"Shen","year":"2022","journal-title":"BMC Infect Dis"},{"key":"2025102617234889700_R18","unstructured":"The Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM). Australasian STI management guidelines for use in primary care. ASHM; 2024."},{"key":"2025102617234889700_R19"},{"issue":"8","key":"2025102617234889700_R20","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1136\/medethics-2011-100256","article-title":"Constraining the use of antibiotics: applying Scanlon\u2019s contractualism.","volume":"38","author":"Millar","year":"2012","journal-title":"J Med Ethics"},{"key":"2025102617234889700_R21","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-019-0485-7","article-title":"Incidence of community onset MRSA in Australia: least reported where it is most prevalent.","volume":"8","author":"Cameron","year":"2019","journal-title":"Antimicrob Resist Infect Control"},{"issue":"1","key":"2025102617234889700_R22","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-017-1801-3","article-title":"Incidence, prevalence, and management of MRSA bacteremia across patient populations \u2013 a review of recent developments in MRSA management and treatment.","volume":"21","author":"Hassoun","year":"2017","journal-title":"Crit Care"}],"container-title":["Sexual Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/doi\/10.1071\/SH24008\/1360290\/sh24008.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/doi\/10.1071\/SH24008\/1360290\/sh24008.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T21:23:52Z","timestamp":1761513832000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/sh\/article\/22\/4\/SH24008\/200046\/A-public-health-ethics-analysis-of-Doxy-PEP"}},"subtitle":[],"editor":[{"given":"Jason","family":"Ong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,7,22]]},"references-count":22,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,8,29]]}},"URL":"https:\/\/doi.org\/10.1071\/sh24008","relation":{},"ISSN":["1448-5028","1449-8987"],"issn-type":[{"value":"1448-5028","type":"print"},{"value":"1449-8987","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,22]]},"article-number":"SH24008"}}