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An important concern is that this could select for tetracycline resistance in these STIs and other species. We searched PubMed and Google Scholar, (1948\u20132023) for randomized controlled trials comparing tetracycline PEP with non-tetracycline controls. The primary outcome was antimicrobial resistance (AMR) to tetracyclines in all bacterial species with available data. Our search yielded 140 studies, of which three met the inclusion criteria. Tetracycline PEP was associated with an increasedprevalence of tetracycline resistance in\n                    <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                    , but this effect was not statistically significant (Pooled OR 2.3, 95% CI 0.9-3.4). PEP had a marked effect on the\n                    <jats:italic>N. gonorrhoeae<\/jats:italic>\n                    tetracycline MIC distribution in the one study where this was assessed. Prophylactic efficacy was 100% at low MICs and 0% at high MICs. In the one study where this was assessed, PEP resulted in a significant increase in tetracycline resistance in commensal\n                    <jats:italic>Neisseria<\/jats:italic>\n                    species compared to the control group (OR 2.9, 95% CI 1.5-5.5) but no significant effect on the prevalence of tetracycline resistance in\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    . The available evidence suggests that PEP with tetracyclines could be associated with selecting tetracycline resistance in\n                    <jats:italic>N. gonorrhoeae<\/jats:italic>\n                    and commensal\n                    <jats:italic>Neisseria<\/jats:italic>\n                    species.\n                  <\/jats:p>","DOI":"10.1186\/s12879-024-09275-3","type":"journal-article","created":{"date-parts":[[2024,4,4]],"date-time":"2024-04-04T09:01:49Z","timestamp":1712221309000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["45 years of tetracycline post exposure prophylaxis for STIs and the risk of tetracycline resistance: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"24","author":[{"given":"Thibaut","family":"Vanbaelen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheeba Santhini","family":"Manoharan-Basil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Kenyon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,4]]},"reference":[{"key":"9275_CR1","doi-asserted-by":"crossref","unstructured":"Mitj\u00e0 O, Padovese V, Folch C, et al. Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe. The Lancet Regional Health\u2013Europe. 2023;34.","DOI":"10.1016\/j.lanepe.2023.100742"},{"issue":"1","key":"9275_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12879-022-07544-7","volume":"22","author":"M Du","year":"2022","unstructured":"Du M, Yan W, Jing W, et al. Increasing incidence rates of sexually transmitted infections from 2010 to 2019: an analysis of temporal trends by geographical regions and age groups from the 2019 global burden of disease study. BMC Infect Dis. 2022;22(1):1\u201316.","journal-title":"BMC Infect Dis"},{"issue":"3","key":"9275_CR3","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1016\/S1473-3099(17)30725-9","volume":"18","author":"J-M Molina","year":"2018","unstructured":"Molina J-M, Charreau I, Chidiac C, et al. 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. Lancet Infect Dis. 2018;18(3):308\u201317.","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"9275_CR4","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1097\/OLQ.0000000000000216","volume":"42","author":"RK Bolan","year":"2015","unstructured":"Bolan RK, Beymer MR, Weiss RE, et al. 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. Sex Transm Dis. 2015;42(2):98.","journal-title":"Sex Transm Dis"},{"issue":"14","key":"9275_CR5","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1056\/NEJMoa2211934","volume":"388","author":"AF Luetkemeyer","year":"2023","unstructured":"Luetkemeyer AF, Donnell D, Dombrowski JC, et al. Postexposure doxycycline to prevent bacterial sexually transmitted infections. N Engl J Med. 2023;388(14):1296\u2013306.","journal-title":"N Engl J Med"},{"key":"9275_CR6","unstructured":"Jean-Michel Molina BB, Lambert Assoumou, Algarte-Genin Michele, Emma Rubenstein, Gilles Pialoux, Christine Katlama, Laure Surgers, Cecile Bebear, Nicolas Dupin, Jean-Paul Viard, Juliette Pavie, Claudine Duvivier, Jade Ghosn, Dominique Costagliola, ANRS 174 DOXYVAC: an open-label randomized trial to prevent STIs in MSM on PrEP. CROI 2023, Seattle, Washington."},{"key":"9275_CR7","doi-asserted-by":"crossref","unstructured":"Kong FYS, Kenyon C, Unemo M. Important considerations regarding the widespread use of doxycycline chemoprophylaxis against sexually transmitted infections. 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Doxycycline post exposure prophylaxis could induce cross-resistance to other classes of antimicrobials in Neisseria gonorrhoeae: an in-silico analysis. Sex Transm Dis. 2023;10(1097)","DOI":"10.1097\/OLQ.0000000000001810"},{"key":"9275_CR11","unstructured":"Luetkemeyer AF, Donnell D, Dombrowski JC, et al. DoxyPEP and antimicrobial resistance in N. gonorrhoeae, commensal Neisseria and S. aureus. CROI 2023, Seattle, Washington."},{"key":"9275_CR12","volume-title":"Doxycycline Post-Exposure Prophylaxis Reduces Incidence of Sexually Transmitted Infections","author":"Population Health Division San Francisco Department of Health","year":"2022","unstructured":"Population Health Division San Francisco Department of Health. Doxycycline Post-Exposure Prophylaxis Reduces Incidence of Sexually Transmitted Infections. 2022."},{"key":"9275_CR13","unstructured":"Stewart J, Bukusi E, Sesay FA, et al. Doxycycline postexposure prophylaxis for prevention of stis among cisgender women. 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