{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T18:12:57Z","timestamp":1794507177004,"version":"4.9.1"},"reference-count":33,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2024,7,17]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This systematic review aimed to identify the efficacy, adherence, safety and impact on antimicrobial resistance of postexposure prophylaxis with doxycycline (Doxy-PEP) in different populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched MEDLINE (via PubMed), Embase and Cochrane CENTRAL databases from inception to 29 May 2024. Two reviewers independently screened the studies and extracted data. We included randomised clinical trials that evaluated the efficacy of Doxy-PEP within 72 hours after condomless sex. A random-effects meta-analysis was conducted to compare the risk of bacterial sexually transmitted infections (STIs) between Doxy-PEP and no prophylaxis. The risk of bias was assessed with the risk-of-bias tool for randomized trials (RoB 2) and the certainty of evidence (CoE) with Grading of Recommendations Assessment, Development and Evaluation (GRADE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four studies were included in the systematic review, totalling 1727 participants. Studies were conducted between 2015 and 2022. Most participants (73%) were men who have sex with men, and the median age of participants varied from 24 to 43 years. Doxy-PEP reduced the risk of having any bacterial STI in different populations by 46% (hazard ratio (HR) 0.54; 95% CI 0.39 to 0.75; CoE moderate), the risk of chlamydia by 65% (relative risk (RR) 0.35; 95% CI 0.15 to 0.82; CoE low) and syphilis by 77% (RR 0.23; 95% CI 0.13 to 0.41; CoE high), without significant effect for risk of gonorrhoea infection (RR 0.90; 95% CI 0.64 to 1.26; CoE very low). The self-reported adherence rate of Doxy-PEP was approximately 80% and one drug-related serious adverse event was reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Doxy-PEP reduced the incidence of chlamydia and syphilis infections. No significant reduction in gonorrhoea infection was observed. This strategy seems promising for some high-risk groups; however, there is still a lack of information on the induction of bacterial resistance and long-term adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42023454123.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2024-056208","type":"journal-article","created":{"date-parts":[[2024,8,3]],"date-time":"2024-08-03T13:21:10Z","timestamp":1722691270000},"page":"59-67","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":44,"title":["Efficacy of postexposure prophylaxis with doxycycline (Doxy-PEP) in reducing sexually transmitted infections: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"101","clinical-trial-number":[{"clinical-trial-number":"nct01473472","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03980223","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04597424","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04050540","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct01473472","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03980223","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04597424","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04050540","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5812-7686","authenticated-orcid":false,"given":"Paulo Roberto","family":"Sokoll","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celina Borges","family":"Migliavaca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"D\u00f6ring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uschi","family":"Traub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karlin","family":"Stark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda Veiga","family":"Sardeli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,8,3]]},"reference":[{"key":"2025012910100567000_101.1.59.1","unstructured":"World Health Organisation (WHO) . Sexually transmitted infections (STIs). WHO; 2019. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/sexually-transmitted-infections (stis)#:~:text=STIs%20have%20a%20profound%20impact,and%20trichomoniasis%20(156%20million) [Accessed 11 Mar 2024]."},{"key":"2025012910100567000_101.1.59.2","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2022.851635","article-title":"Incidence trends of five common sexually transmitted infections excluding HIV from 1990 to 2019 at the global, regional, and national levels: results from the global burden of disease study 2019","volume":"9","author":"Fu","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"2025012910100567000_101.1.59.3","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(21)00221-7"},{"key":"2025012910100567000_101.1.59.4","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-021-01786-3","article-title":"Sero-prevalence of syphilis and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis","volume":"10","author":"Geremew","year":"2021","journal-title":"Syst Rev"},{"key":"2025012910100567000_101.1.59.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-021-06680-w","article-title":"Re-emergence of syphilis in women of reproductive age and its association with the increase in congenital syphilis in Mexico during 2010-2019: an ecological study","volume":"21","author":"Garc\u00eda-Cisneros","year":"2021","journal-title":"BMC Infect Dis"},{"key":"2025012910100567000_101.1.59.6","unstructured":"World Health Organization (WHO) . Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030. WHO; 2022. Available: https:\/\/iris.who.int\/bitstream\/handle\/10665\/360348\/9789240053779-eng.pdf?sequence=1 [Accessed 11 Mar 2024]."},{"key":"2025012910100567000_101.1.59.7","unstructured":"Joseph S . Initiation of doxycycline pre-exposure prophylaxis in patients attending an HIV prep clinic\u2014Philadelphia, 2019. STD Prevention Conference. Virtual. Available: https:\/\/s6.goeshow.com\/ncsd\/prevention\/2020\/week_2_schedule.cfm?session_key=A70A6700-A0F0-B8AC-8A0D-58558450E557&session_date=Monday,%20Sep%2021,%202020 [accessed 11 Sep 2024]"},{"key":"2025012910100567000_101.1.59.8","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000216"},{"key":"2025012910100567000_101.1.59.9","doi-asserted-by":"crossref","unstructured":"Holmes NE , Charles PGP . Safety and efficacy review of doxycycline. Clin Med Ther 2009;1. doi:10.4137\/CMT.S2035","DOI":"10.4137\/CMT.S2035"},{"key":"2025012910100567000_101.1.59.10","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkx420"},{"key":"2025012910100567000_101.1.59.11","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000001395"},{"key":"2025012910100567000_101.1.59.12","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30725-9"},{"key":"2025012910100567000_101.1.59.13","unstructured":"New York City Department of Health and Mental Hygiene . Doxycycline post-exposure prophylaxis (doxy-PEP) to prevent bacterial sexually transmitted infections 2023. 2023. Available: https:\/\/www.nyc.gov\/assets\/doh\/downloads\/pdf\/std\/dear-colleague-doxy-PEP-to-prevent-bacterial-STI-11092023.pdf [accessed 26 May 2024]"},{"key":"2025012910100567000_101.1.59.14","unstructured":"DiMarco DE , Urban MA , Fine SM , et al . Doxycycline post-exposure prophylaxis to prevent bacterial sexually transmitted infections. Baltimore (MD): Johns Hopkins University, 2023. 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Cochrane Handbook for Systematic Reviews of Interventions Version 6.3. Cochrane, 2022."},{"key":"2025012910100567000_101.1.59.21","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"10","author":"Page","year":"2021","journal-title":"Syst Rev"},{"key":"2025012910100567000_101.1.59.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2025012910100567000_101.1.59.23","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h870","article-title":"Use of GRADE for assessment of evidence about prognosis: rating confidence in estimates of event rates in broad categories of patients","volume":"350","author":"Iorio","year":"2015","journal-title":"BMJ"},{"key":"2025012910100567000_101.1.59.24","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2211934"},{"key":"2025012910100567000_101.1.59.25","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2304007"},{"key":"2025012910100567000_101.1.59.26","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-023-02413-0","article-title":"Characteristics of kenyan women using HIV prep enrolled in a randomized trial on doxycycline postexposure prophylaxis for sexually transmitted infection prevention","volume":"23","author":"Oware","year":"2023","journal-title":"BMC Womens Health"},{"key":"2025012910100567000_101.1.59.27","doi-asserted-by":"crossref","unstructured":"Molina J-M , Bercot B , Assoumou L , et al . 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\u2008\u00d7\u20082 factorial design. 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