{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T06:48:02Z","timestamp":1776581282031,"version":"3.51.2"},"reference-count":24,"publisher":"CSIRO Publishing","issue":"4","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":51,"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 consideration of doxycycline post-exposure prophylaxis to prevent STIs in gay, bisexual and other men who have sex with men. On 6 June 2024, the US Centers for Disease Control and Prevention added the intervention to its clinical guidelines. 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 post-exposure prophylaxis until further research is done. Thus, the use of doxycycline post-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\/sh24013","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T06:22:39Z","timestamp":1753424559000},"source":"Crossref","is-referenced-by-count":2,"title":["A public health ethics analysis of Doxy-PEP: arguments for and against \u2013 the \u2018yes\u2019 case"],"prefix":"10.1071","volume":"22","author":[{"given":"Sam","family":"Templeman","sequence":"first","affiliation":[{"name":"BUNSW School of Population Health, Sydney, NSW, Australia. Email: samt119@hotmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0657-9610","authenticated-orcid":true,"given":"Bridget","family":"Haire","sequence":"additional","affiliation":[{"name":"AKirby Institute and School of Population Health, UNSW Sydney, Sydney, NSW, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"67","published-online":{"date-parts":[[2025,7,22]]},"reference":[{"key":"2025102617262943200_R1","doi-asserted-by":"publisher","DOI":"10.1056\/nejm-jw.NA56359","article-title":"Global resurgence of syphilis (Including Congenital Syphilis).","author":"Wald","year":"2023","journal-title":"NEJM J Watch"},{"key":"2025102617262943200_R2","unstructured":"King J, McManus H, Kwon A, Gray R, McGregor S. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual surveillance report 2022. Sydney: UNSW; 2022. Available at https:\/\/www.kirby.unsw.edu.au\/sites\/default\/files\/documents\/Annual-Surveillance-Report-2022_STI.pdf [cited 22 October 2023]"},{"issue":"3","key":"2025102617262943200_R3","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1071\/SH18215","article-title":"Estimating the syphilis epidemic among gay, bisexual and other men who have sex with men in Australia following changes in HIV care and prevention.","volume":"16","author":"Wilkinson","year":"2019","journal-title":"Sex Health"},{"issue":"11","key":"2025102617262943200_R4","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"},{"key":"2025102617262943200_R5","doi-asserted-by":"crossref","unstructured":"Cornelisse V, Riley B, Medland N, Round Table Participants. 2023 Consensus Statement on doxycycline prophylaxis (Doxy-PEP) for the prevention of syphilis, chlamydia and gonorrhoea among gay, bisexual, and other men who have sex with men in Australia; 2023. Available at https:\/\/ashm.org.au\/about\/news\/doxy-pep-statement","DOI":"10.5694\/mja2.52258"},{"issue":"4","key":"2025102617262943200_R6","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1089\/apc.2023.0289","article-title":"Doxycycline as postsexual exposure prophylaxis: use, acceptability, and associated sexual health behaviors among a multi-site sample of clinical trial participants.","volume":"38","author":"Fredericksen","year":"2024","journal-title":"AIDS Patient Care STDS"},{"issue":"14","key":"2025102617262943200_R7","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":"2025102617262943200_R8","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":"10","key":"2025102617262943200_R9","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1016\/S1473-3099(24)00236-6","article-title":"Doxycycline prophylaxis and meningococcal group B vaccine to prevent bacterial sexually transmitted infections in France (ANRS 174 DOXYVAC): a multicentre, open-label, randomised trial with a 2 \u00d7 2 factorial design.","volume":"24","author":"Molina","year":"2024","journal-title":"Lancet Infect Dis"},{"issue":"7","key":"2025102617262943200_R10","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1097\/OLQ.0b013e31820e64fd","article-title":"Chemoprophylaxis is likely to be acceptable and could mitigate syphilis epidemics among populations of gay men.","volume":"38","author":"Wilson","year":"2011","journal-title":"Sex Transm Dis"},{"key":"2025102617262943200_R11","unstructured":"World Health Organization. Syphilis; 2024. Available at https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/syphilis#:~:text=Syphilis%20is%20a%20preventable%20and,pregnancy%20and%20through%20blood%20transfusion"},{"issue":"25","key":"2025102617262943200_R12","doi-asserted-by":"publisher","first-page":"2331","DOI":"10.1056\/NEJMoa2304007","article-title":"Doxycycline Prophylaxis to Prevent Sexually Transmitted Infections in Women.","volume":"389","author":"Stewart","year":"2023","journal-title":"N Engl J Med"},{"issue":"1","key":"2025102617262943200_R13","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"},{"issue":"2","key":"2025102617262943200_R14","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1071\/SH23011","article-title":"Interim position statement on doxycycline post-exposure prophylaxis (Doxy-PEP) for the prevention of bacterial sexually transmissible infections in Australia and Aotearoa New Zealand \u2013 the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM).","volume":"20","author":"Cornelisse","year":"2023","journal-title":"Sex Health"},{"issue":"3","key":"2025102617262943200_R15","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":"2017","journal-title":"J Antimicrob Chemother"},{"key":"2025102617262943200_R16","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"},{"key":"2025102617262943200_R17","unstructured":"Bellefleur O, Keeling M. Utilitarianism in public health. National Collaborating Centre for Healthy Public Policy; 2016. Available at http:\/\/www.ncchpp.ca\/docs\/2016_Ethics_Utilitarianism_En.pdf [cited 22 October 2023]"},{"key":"2025102617262943200_R18"},{"issue":"6","key":"2025102617262943200_R19","doi-asserted-by":"publisher","first-page":"e417","DOI":"10.1016\/S2666-5247(22)00035-0","article-title":"Characterisation of Treponema pallidum lineages within the contemporary syphilis outbreak in Australia: a genomic epidemiological analysis.","volume":"3","author":"Taouk","year":"2022","journal-title":"Lancet Microbe"},{"issue":"1","key":"2025102617262943200_R20","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-019-12053-4","article-title":"Bridging of Neisseria gonorrhoeae lineages across sexual networks in the HIV pre-exposure prophylaxis era.","volume":"10","author":"Williamson","year":"2019","journal-title":"Nat Commun"},{"issue":"1","key":"2025102617262943200_R21","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1093\/bmb\/ldab030","article-title":"Ethics and antibiotic resistance.","volume":"141","author":"Jamrozik","year":"2022","journal-title":"Br Med Bull"},{"issue":"4","key":"2025102617262943200_R22","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1071\/SH22053","article-title":"Why risk matters for STI control: who are those at greatest risk and how are they identified?","volume":"19","author":"Traeger","year":"2022","journal-title":"Sex Health"},{"key":"2025102617262943200_R23","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1071\/SH23036","article-title":"The impact of social connections and discrimination to HIV risk among Asian gay and bisexual men in Australia.","volume":"20","author":"Chan","year":"2023","journal-title":"Sex Health"},{"key":"2025102617262943200_R24","unstructured":"European Parliament. The precautionary principle: definitions, applications and governance; 2015. Available at https:\/\/www.europarl.europa.eu\/thinktank\/en\/document\/EPRS_IDA(2015)573876 [cited 22 October 2023]"}],"container-title":["Sexual Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/doi\/10.1071\/SH24013\/1361746\/sh24013.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/doi\/10.1071\/SH24013\/1361746\/sh24013.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T21:26:32Z","timestamp":1761513992000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/sh\/article\/22\/4\/SH24013\/200631\/A-public-health-ethics-analysis-of-Doxy-PEP"}},"subtitle":[],"editor":[{"given":"Jason","family":"Ong","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,7,22]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,8,29]]}},"URL":"https:\/\/doi.org\/10.1071\/sh24013","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":"SH24013"}}