{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:25:35Z","timestamp":1791890735817,"version":"4.3.4"},"reference-count":42,"publisher":"CSIRO Publishing","issue":"2","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/doi.org\/10.1071\/journalslicense"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recent systematic reviews have demonstrated the efficacy of doxycycline prophylaxis in preventing bacterial sexually transmitted infections (STIs)\u00a0in randomised controlled trials (RCTs). In this review, we updated evidence from RCTs and non-RCTs and compared the effectiveness of doxycycline as pre- (doxy PrEP) and post-prophylaxis (doxy PEP) across different groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed, Web of Science, Embase, Cochrane Library, and two conference abstract archives for publications from January 2010 to April 2025. Eligible RCT and non-RCT studies on doxy PrEP and doxy PEP to prevent STIs were included in the analysis.\u00a0Pooled risk ratios were calculated using fixed-effects and random-effects models. This study was registered with PROSPERO (CRD42024568934).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fourteen eligible studies (4 doxy PrEP, 10 doxy PEP) were included for analysis. Participants were primarily men who have sex with men (MSM) and transgender women (TGW). Doxycycline (either PrEP or PEP) reduced the risk of acquiring any STIs by 60% (risk ratio (RR),\u00a00.40;\u00a095% CI,\u00a00.30\u20130.52) in RCT and non-RCT trials. Doxycycline was associated with fewer incidences of chlamydia (RR,\u00a00.18;\u00a095% CI,\u00a00.11\u20130.28), gonorrhoea (RR,\u00a00.61;\u00a095% CI: 0.44\u20130.86), and syphilis (RR,\u00a00.20; 95% CI;\u00a00.12\u20130.33). Meta-analysis of seven RCTs showed 76% decrease on chlamydia (RR: 0.24; 95% CI: 0.13\u20130.45), 33% decrease on gonorrhoea (RR,\u00a00.67; 95% CI;\u00a00.45\u20130.98), and 78% decrease on syphilis (RR,\u00a00.22; 95% CI;\u00a00.14\u20130.36). HIV-positive and HIV-negative people benefited from using doxy PrEP and PEP regimens prevented bacterial STIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>RCT and non-RCT data demonstrated the effectiveness of doxy PrEP and doxy PEP in reducing STIs among MSM\/TGW. Integrating doxy PrEP or doxy PEP as a biomedical tool into STI prevention strategies should be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/sh25227","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T13:02:39Z","timestamp":1773061359000},"source":"Crossref","is-referenced-by-count":2,"title":["Doxycycline prophylaxis is effective as pre-exposure and post-exposure regimens in the prevention of sexually transmitted infections: an updated systematic review and meta-analysis"],"prefix":"10.1071","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5399-3443","authenticated-orcid":true,"given":"Peipei","family":"Zhao","sequence":"first","affiliation":[{"name":"ADepartment of Social Medicine and Implementation Science, School of Public Health, Nanjing Medical University, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8251-2478","authenticated-orcid":true,"given":"Qian","family":"Zou","sequence":"additional","affiliation":[{"name":"BDepartment of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2804-1181","authenticated-orcid":true,"given":"Joseph","family":"Tucker","sequence":"additional","affiliation":[{"name":"CClinical Research Department, London School of Hygiene and Tropical Medicine, London, UK."},{"name":"DDepartment of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"EDivision of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9026-707X","authenticated-orcid":true,"given":"Weiming","family":"Tang","sequence":"additional","affiliation":[{"name":"DDepartment of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"67","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"2026030909023254300_R1","unstructured":"World Health Organization. Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030; 2022. Available at https:\/\/iris.who.int\/bitstream\/handle\/10665\/360348\/9789240053779-eng.pdf?sequence=1 [accessed 4 July 2024]"},{"key":"2026030909023254300_R2","unstructured":"World Health Organization. Implementing the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, 2022\u20132030: report on progress and gaps 2024; 2024. Available at https:\/\/iris.who.int\/bitstream\/handle\/10665\/378246\/9789240097872-eng.pdf?sequence=1 [accessed 1 August 2024]"},{"key":"2026030909023254300_R3","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1056\/NEJM200107123450201","article-title":"Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite.","volume":"345","author":"Nadelman","year":"2001","journal-title":"N Engl J Med"},{"key":"2026030909023254300_R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2024.107186","article-title":"Doxycycline prophylaxis for the prevention of sexually transmitted infections: a systematic review and meta-analysis of randomized controlled trials.","volume":"147","author":"Szondy","year":"2024","journal-title":"Int J Infect Dis"},{"key":"2026030909023254300_R5","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1136\/sextrans-2024-056208","article-title":"Efficacy of postexposure prophylaxis with doxycycline (Doxy-PEP) in reducing sexually transmitted infections: a systematic review and meta-analysis.","volume":"101","author":"Sokoll","year":"2025","journal-title":"Sex Transm Infect"},{"key":"2026030909023254300_R6","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1097\/OLQ.0000000000000216","article-title":"Doxycycline prophylaxis to reduce incident syphilis among HIV-infected men who have sex with men who continue to engage in high-risk sex: a randomized, controlled pilot study.","volume":"42","author":"Bolan","year":"2015","journal-title":"Sex Transm Dis"},{"key":"2026030909023254300_R7","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"},{"key":"2026030909023254300_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"},{"key":"2026030909023254300_R9","doi-asserted-by":"publisher","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"},{"key":"2026030909023254300_R10","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"},{"key":"2026030909023254300_R11","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"},{"key":"2026030909023254300_R12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7302a1","article-title":"CDC clinical guidelines on the use of doxycycline postexposure prophylaxis for bacterial sexually transmitted infection prevention, United States, 2024.","volume":"73","author":"Bachmann","year":"2024","journal-title":"MMWR Recomm Rep"},{"key":"2026030909023254300_R13","unstructured":"National Advisory Committee on Sexually Transmitted and Blood-Borne Infections (NAC-STBBI). Recommendations on the use of prophylactic doxycycline for the prevention of bacterial STI (chlamydia, gonorrhea, syphilis); 2025. Available at https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/canadian-guidelines\/national-advisory-committee-stbbi\/recommendations-prophylactic-doxycycline-prevention-bacterial-sti-chlamydia-gonorrhea-syphilis.html#a6 [accessed 13 January 2026]"},{"key":"2026030909023254300_R14","doi-asserted-by":"publisher","first-page":"381","DOI":"10.5694\/mja2.52258","article-title":"Australian consensus statement on doxycycline post-exposure prophylaxis (doxy-PEP) for the prevention of syphilis, chlamydia and gonorrhoea among gay, bisexual and other men who have sex with men.","volume":"220","author":"Cornelisse","year":"2024","journal-title":"Med J Aust"},{"key":"2026030909023254300_R15","doi-asserted-by":"publisher","DOI":"10.1016\/J.LANEPE.2023.100738","article-title":"Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe.","volume":"34","author":"G\u00f6kengin","year":"2023","journal-title":"Lancet Reg Health Eur"},{"key":"2026030909023254300_R16","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1136\/sextrans-2022-055425","article-title":"BASHH updated position statement on doxycycline as prophylaxis for sexually transmitted infections.","volume":"98","author":"Kohli","year":"2022","journal-title":"Sex Transm Infect"},{"key":"2026030909023254300_R17","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1111\/ddg.15282","article-title":"Position statement of the German STI Society on the prophylactic use of doxycycline to prevent STIs (Doxy-PEP, Doxy-PrEP).","volume":"22","author":"Werner","year":"2024","journal-title":"J Dtsch Dermatol Ges"},{"key":"2026030909023254300_R18","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1097\/OLQ.0000000000002224","article-title":"Doxycycline postexposure prophylaxis is effective and highly acceptable in an urban public sexually transmitted disease clinic: Philadelphia, 2019\u20132023.","volume":"52","author":"Lewis","year":"2025","journal-title":"Sex Transm Dis"},{"key":"2026030909023254300_R19","doi-asserted-by":"publisher","first-page":"1831","DOI":"10.1007\/s15010-023-02086-9","article-title":"Already current practice? 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Available at https:\/\/www.croiconference.org\/abstract\/doxycycline-postexposure-prophylaxis-to-prevent-trichomonas-vaginalis-among-cisgender-women\/"},{"key":"2026030909023254300_R30","unstructured":"Bacon O, Koh RP, Glidden DV, et al. Doxy-PEP effectiveness in men who have sex with men (MSM) and transgender women (TGW) on HIV PrEP. Conference on Retroviruses and Opportunistic Infections (CROI); Denver, Colorado, USA; 2024. Available at https:\/\/www.croiconference.org\/abstract\/doxy-pep-effectiveness-in-men-who-have-sex-with-men-msm-and-transgender-women-tgw-on-hiv-prep\/"},{"key":"2026030909023254300_R31","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlaf054","article-title":"Doxycycline pre-exposure prophylaxis prevents sexually transmitted infections without affecting vaginal bacterial flora in female sex workers.","volume":"7","author":"Abe","year":"2025","journal-title":"JAC Antimicrob Resist"},{"key":"2026030909023254300_R32","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1001\/jamainternmed.2024.7186","article-title":"Doxycycline postexposure prophylaxis and bacterial sexually transmitted infections among individuals using HIV preexposure prophylaxis.","volume":"185","author":"Traeger","year":"2025","journal-title":"JAMA Intern Med"},{"key":"2026030909023254300_R33","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaf043","article-title":"A pilot, randomized controlled trial of dual daily HIV and sexually transmitted infection pre-exposure prophylaxis using tenofovir disoproxil fumarate\/emtricitabine and doxycycline in gay, bisexual, and other men who have sex with men and transgender women: the DuDHS Study.","author":"Grennan","year":"2025","journal-title":"Clin Infect Dis"},{"key":"2026030909023254300_R34","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofaf089","article-title":"Doxycycline postexposure prophylaxis for bacterial STIs: prescribing patterns, use, short-term outcomes among 2083 patients in a Los Angeles federally qualified health care program, and implications for widespread use.","volume":"12","author":"Osmundson","year":"2025","journal-title":"Open Forum Infect Dis"},{"key":"2026030909023254300_R35","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/S1473-3099(24)00726-6","article-title":"DoxyPEP: real-life effectiveness in a cohort of men who have sex with men in Milan, Italy.","volume":"25","author":"Raccagni","year":"2025","journal-title":"Lancet Infect Dis"},{"key":"2026030909023254300_R36","unstructured":"Grennan T, Tan DHS, Mohammed S, et al. 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