A ‘morning after pill’ for sexually transmitted infections is almost here

Medicine can be about to achieve a long-sought goal: a “morning after pill” to prevent sexually transmitted infections. This could significantly reduce soaring disease rates and huge health care costs.

The effectiveness of this pill – and it’s literally a pill, a 200 milligram tablet of the antibiotic doxycycline – has been studied for a decade, and people have been taking it secretly for years. But the results of the study published In The New England Journal of Medicine seem likely to tip the pill in clinical practice. In the study, conducted in San Francisco and Seattle, participants who took a single dose within 72 hours of having sex without a condom were only a third more likely to contract chlamydia, gonorrhea or syphilis than those who did not take the pills.

As with everything in medicine, there are footnotes to results and risks to balance the benefits. The study was conducted only with gay and bisexual men, as well as transgender women and non-binary people designated as male at birth. Within these groups, it was limited to people who had been diagnosed with a sexually transmitted infection (STI) in the previous year. The study did not include cisgender women; in previous studies, the preventative antibiotic did not work as well for them. And the study noted, but did not explore in depth, the possibility that routine administration of an antibiotic could provoke resistance either among the bacteria that cause STIs or others carried in the participants’ bodies.

That said, the results have created real excitement among doctors and people who would be eligible to take what’s called doxyPEP (for doxycycline post-exposure prophylaxis) – even though health authorities, such as the Centers for Disease Control and Prevention in the United States, have not yet made formal recommendations for its use.

“I think this is a real game-changer,” says Paul Adamson, an infectious disease physician and assistant clinical professor of medicine at the University of California, Los Angeles. “We have a huge amount of bacterial STIs in the United States. Gay and bisexual men who have sex with men are disproportionately burdened with them. And we haven’t had a lot of tools that we can use to help .

To understand why doxyPEP might be so important, it’s important to consider what happened with STIs. In short: They are soaring. Since 2017, According to the CDC, the most important of these diseases has reached historic highs: gonorrhea has increased by 28% and syphilis by 74%. And although chlamydia diagnoses have not quite returned to pre-Covid levels, the agency fears this is due to pandemic disruptions in care, rather than an actual decrease in transmission. All of these infections have profound long-term consequences if not diagnosed and treated, including making people more vulnerable to HIV infection. Collectively, they are costing the US healthcare system over $1 billion per year.

Meanwhile, congenital syphilis – passed from mother to child at birth, a sign that the pregnant person never received adequate prenatal care – caused 220 stillbirths and infant deaths in 2021, the latest year for which there are national figures. Gonorrhea wins resistance to the latest antibiotics currently available to process it.