A cross-sectional analysis of doxyPEP use and outcomes in Michigan, United States

Document Type

Article

Publication Date

9-15-2025

Publication Title

International journal of STD & AIDS

Abstract

Background: In 2024, national guidance was issued for doxycycline post-exposure prophylaxis (doxy-PEP) to prevent bacterial sexually transmitted infections (STIs). The study purpose was to evaluate doxy-PEP use in patients with increased risk of STI exposure at a large, urban health system.

Methods: IRB-exempt study of adult patients with clinic encounters for increased risk of STI exposure and testing for N. gonorrhoeae, C. trachomatis, and T. pallidum from 01/01/2023-31/10/2024. Patients were identified using ICD-10 code Z20.XX and STI testing. Doxy-PEP prescription utilization was evaluated after a dedicated doxy-PEP order was implemented with appropriate patient counseling instructions. The primary outcome was the proportion of doxy-PEP prescriptions utilized in at-risk patients; secondary outcomes were utilization of the dedicated doxy-PEP order and abnormal STI testing within 3-months of the doxy-PEP prescription.

Results: 4234 high-risk sexual patient encounters were documented; 7.37% of patients received a doxy-PEP prescription. Of these, 29.5% were ordered utilizing a dedicated doxy-PEP order. Most patients who received a doxy-PEP prescription were Black (96.6%), men (92.6%), with a median (IQR) age of 29 (24-37) years, and had private/commercial insurance (42%). One patient had abnormal syphilis testing within 3-months of doxy-PEP prescription.

Conclusions: These findings highlight doxy-PEP underutilization and the need for broader provider engagement and advanced antimicrobial stewardship interventions.

Medical Subject Headings

Chlamydia; Gonorrhea; North America; location; Syphilis; bacterial disease; pre-exposure prophylaxis

PubMed ID

40953601

ePublication

ePub ahead of print

First Page

9564624251379701

Last Page

9564624251379701

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