IDSA and HIVMA Response to New CDC Guidelines 
on Doxycycline as Post-Exposure Prophylaxis 

IDSA and HIVMA welcome the Centers for Disease Control and Prevention’s guidelines for implementing doxycycline as post-exposure prophylaxis, or doxy PEP, to prevent sexually transmitted infections. Doxy PEP is the only biomedical intervention to prevent bacterial STIs and comes at a time when we urgently need new tools and approaches to control the STI epidemic. 

CDC reported more than 2.5 million cases of chlamydia, gonorrhea and syphilis in the United States in 2022. The report also noted a 79% increase in syphilis and a 183% increase in congenital syphilis from 2018 to 2022. Given the severe complications and increase in risk of HIV transmission that bacterial STIs can cause, it is imperative to deploy every effective tool available to prevent them.

We support CDC’s plan for monitoring for antibiotic resistance as doxy PEP is rolled out. Based on current data, doxy PEP’s benefits to individual and public health outweigh the risk of resistance, but close monitoring and research will be important. Increased funding for CDC to respond to the STI epidemic, including resources to implement doxy PEP and expand antibiotic resistance monitoring and screening, is urgently needed to change the alarming trajectory of new STI cases in the United States.

—Steven K. Schmitt, MD, FIDSA — President, IDSA
—Allison Agwu, MD, ScM, FIDSA — Chair, HIV Medicine Association