Is DoxyPep the solution to rising STI rates among men who have sex with men?
Sexual health services are struggling to cope with the demand for screening and treatment.
Sexual health services in the UK are reporting soaring rates of gonorrhoea, chlamydia, and syphilis, and their data indicates that it's men who have sex with men that are most at risk.
"There a combination of reasons why we’re seeing a rise in cases..." explains Ian Howley, chief executive of LGBT Hero - a national health and wellbeing charity. "There’s been less sexual health awareness messages over the last few years, and people are struggling to book an appointment to test for STIs - which has a knock on effect in terms of stopping the spread. There's also the increase of comdomless sex due to PrEP, and we're still in a hangover from the pandemic when people didn’t test and may have carried some STIs for longer than they would normally. All these factors are playing into a system where we are seeing a rise in STIs among men who have sex with men."
Worryingly, under-resourcing of sexual health clinics in the UK is leaving people without the testing and treatment needed to contain and minimise the harm of STIs.
"Over the last few years, we’ve seen a decrease in funding for sexual health and HIV prevention..." says Ian Howley. "The government has big aims to end HIV by 2030 but it’s not showing that in how it funds sexual health services. Sexual health and HIV prevention is a not a one-size-fits-all approach and, in many ways, has become very medicalised and less about holistic wellbeing issues – such as tackling mental wellbeing issues that are linked to poorer sexual health. I feel that we’ve lost the community drive that used to exist - sexual health right now is very flat. A new approach is needed not just to make people aware about HIV and STIs but to allow people to have the best sex with the least amount of risk. Let’s put the sex back into the sexual health!"
With the UK's health service increasingly unable to cope with demand, it seems that many men are turning to DoxyPEP to try and mitigate potential exposure to STIs.
What is DoxyPEP?
DoxyPEP refers to the use of Doxycycline - a broad-spectrum antibiotic.
Doxycycline is primarily used to treat infections caused by bacteria and is frequently used in the treatment of bacterial pneumonia and acne. However, always the innovators, the gays have discovered that taking Doxycycline after sex can help to prevent the acquisition of any STIs that your hook-up might be bringing to the party.
It's referred to as DoxyPEP because the Doxycycline is being taken as a post-exposure prophylactic.
Doxycycline usually comes in capsule form and is taken orally.
"I think DoxyPEP could be an excellent way of tackling STIs in our community..." confirms Ian Howley. "However, it’s clear more research needs to be done to figure out the exact benefit this will have. From the research we do have, it’s clear that it has some benefit. Right now, this method has not been approved for use in the UK and many men are self-sourcing. It’s not ideal and I’d prefer if we could speed up this process as part of a trial similar to PrEP. DoxyPEP could be a real benefit to those who engage in group sex or have lots of different sexual partners."
While the UK has not approved the use of DoxyPEP as a tool against STI transmission, the US Centers for Disease Control and Prevention has issued some proposed guidelines.
The general strategy that most people follow is to take a dose of Doxycycline as soon as possible after your sexual encounter - ideally within 24 hours. If you're taking DoxyPEP more than 72 hours after your sexual encounter it's probably too late to have significant benefit.
It’s important to remember that a Doxy PEP strategy isn’t going to protect you from all the STIs that you might encounter. While taking Doxycycline should give you some protection against STIs such as gonorrhoea, chlamydia, and syphilis, it won’t protect you against STIs such as HIV or Mpox, so keep up your PrEP schedule and get vaccinated.
You also need to be aware that DoxyPEP is not without side-effects. Antibiotics work by killing bacteria. Like most antibiotics, Doxycycline can’t distinguish between “good” and “bad” bacteria. That’s why an antibiotic such as Doxycycline will disrupt your digestive system – it will kill the “good” bacteria in your gut that are essential to healthy digestion. This bacteria is often referred to as your gut microbiome. How that might present itself is that you might experience diarrhoea or an upset stomach after taking Doxycycline. If you take Doxycycline frequently, your gut microbiome doesn't get a chance to recover and you could compromise your digestive health.
Disclaimer – we’re not doctors, so don’t rely on us for medical advice. Speak to your local health service or your GP to ensure that taking Doxycycline is suitable for you. Availability of Doxycycline will vary depending on where you are in the world. As a general guide, Doxycycline normally requires a prescription from a doctor. It's worth noting that not every medical professional will be in favour of you taking Doxycycline. There are concerns that the widespread use of antibiotics – particularly in a post-exposure-prophylactic scenario – can increase viral and bacterial resistance, making the antibiotics less effective for the general population. If you seek a prescription for Doxycycline, you may need to be assertive and transparent in explaining why you want to take the antibiotic.
How often should you test for STIs?
One of the reasons for higher rates of STI infection being reported among men who have sex with men is likely to be that the LGBTQ community are more likely to be engaged with a sexual health service and testing more regularly.
If you're sexually active, you should - at a minimum - be testing for STIs at least every 12 months. If you’re having sex with multiple partners – that means if you’re active on the hook-up and dating apps and enjoying regular encounters – then you should be getting tested more frequently, such as every three to six months.
Testing is easy and straightforward. Home testing kits are widely available, sexual health clinics will generally provide free testing, or your local doctor will be able to complete the tests. If the tests return any positive results, then you’ll be treating early, getting on top of any problems, and ensuring that you’ve got the all clear to get back out there and get amongst it.
What do I need to know about STIs?
Part of taking care of yourself is being fairly educated when it comes to sexual health.
Obviously, STIs don’t make moral judgements about you or the sex that you’re having. Whether we’re in a long-term relationship or volunteering to be the cum-dump for Tuesday night’s gang-fuck, it’s a level playing field – we can all transmit and acquire the same STIs.
While there’s no moral hierarchy when it comes to sex and STIs, the more that you know about your own health and the health of your sexual partners, the more confident that you can be about where you stand in relation to STIs. Having an open and frank discussion about sexual health is much easier if you’re in a relationship or you have a regular fuck-buddy, but it’s not so straightforward when it comes to hookups.
One of the exciting aspects of a hookup is precisely the lack of information shared. It’s probably a one-off encounter. You might know his screen-name, but not much more. You might not even see his face – he could just be an anonymous hard cock pushed through a hole in the wall of the toilet cubicle.
Whatever kind of sex you're having, and whoever you're having sex with, if you're sexually active then you need to be regularly testing for STIs. The sooner an infection is identified, the quicker and easier it is to treat it and keep you healthy.
How often should I get tested for STIs?
The CDC – the Centers for Disease Prevention and Control in the US – recommends that men who have sex with men should be tested for STIs at least every 12 months. If you’re having sex with multiple partners – that means if you’re active on the hook-up and dating apps and enjoying regular encounters – then you should be getting tested more frequently, such as every three to six months.
Testing is easy and straightforward. Home testing kits are widely available, sexual health clinics will generally provide free testing, or your local doctor will be able to complete the tests. If the tests return any positive results, then you’ll be treating early, getting on top of any problems, and ensuring that you’ve got the all clear to get back out there and get amongst it.
Which STIs should I be testing for?
Shigella
Shigella affects the digestive tract and usually causes inflammatory diarrhoea that can be bloody. The infection may also lead to fever and abdominal cramping - it's frequently mistaken for food poisoning.
Most people that acquire a shigella infection will recover without any treatment or medication – effective medication helps shorten the illness’s duration. Those living with HIV, in particular, benefit from antibiotic treatment.
Shigella is a pretty aggressive bacteria – you only need the smallest amount of contact for the infection to be transmitted. You can get Shigella by eating food that has been contaminated with the bacteria, but – for guys who have sex with guys – our biggest exposure is during sex.
The Shigella bacteria is found in faecal matter – your faeces, your shit. So, if you come into contact with even the smallest amount of faecal matter that contains the bacteria, then it’s likely that you’ll pick up the infection.
Rimming is the most likely point of transmission – because your mouth is likely to make direct contact with the bacteria. But any scenario where ass-play is involved – fingering, using toys, fisting – could involve you coming into contact with the Shigella bacteria.
Hygiene is your best defence against Shigella. Try and ensure that you’ve both had a shower and thoroughly washed before the fun gets underway. If you’re fisting, using gloves may help provide some protection.
If you've been diagnosed with Shigella, it’s important that you avoid sexual contact until fully recovered – to avoid transmitting the bacteria to others. It usually takes about 10 days to get rid of the bacteria from your body – antibiotics can be prescribed.
HIV
While we are seeing a decline of HIV transmission rates in some cities. HIV remains the most serious STI that men who have sex with men are likely to encounter.
You’re probably not going to know the HIV status of your sexual partners. There’s no visual indicators, and even if they tell you what their status is, you’ve got no way of verifying their testing history or viral load.
What’s essential is that you know what your status is. If you have acquired HIV, then your treatment will most likely mean that your viral load will be undetectable and you won’t be able to transmit the virus to anyone else. If you don’t have HIV, then you’ll be able to use PrEP to protect yourself against the virus. Condoms can also help to prevent the transmission of HIV.
You’re most at risk of acquiring HIV if you get fucked by a guy who has HIV but is not on treatment (and so is likely to have a high viral load) and you’re not on PrEP and a condom isn’t used.
Gonorrhoea and Chlamydia
Gonorrhoea and Chlamydia are both bacterial infections – they’re different, but there’s a lot of similarities between them. You could acquire a Gonorrhoea or Chlamydia infection in your dick, your butt, your throat, or your eyes.
The infection can be transmitted through any sort of contact. Condoms are effective in preventing transmission of the bacteria when it comes to fucking or getting fucked, but you’re still exposed when sucking cock or rimming.
Symptoms could range from having a sore throat, to discomfort when you’re urinating, to a discharge from your butt. You may be infected but not have any noticeable symptoms. Gonorrhoea and Chlamydia are pretty common infections, so this is something you should be proactively thinking about.
Both Gonorrhoea and Chlamydia can be cleared up through antibiotics, although strains of drug-resistant Gonorrhoea are now emerging. If you present to your sexual health clinic with symptoms, or if it’s picked up during your regular testing, once you’ve completed the course of antibiotics for Gonorrhoea, they’ll test you again to make sure that the drugs have worked and that you’re good to go.
Mpox
This is not technically an STI but does seem to be effectively transmitted through sexual contact. There’s effective vaccinations against Monkeypox so make sure you’ve got yourself covered.
Crabs
These are pubic lice that are transmitted through physical contact. You can get a cream from your pharmacist without a prescription.
Genital warts
Transmitted by physical content, these are abnormal skin growths caused by the human papilloma virus (HPV). Treatment is difficult, so best to avoid touching anything that looks like genital warts. A vaccine has been developed and is becoming more widely available.
Herpes
This is a virus that is spread by skin to skin contact. There are two forms of herpes – HSV-1 which causes cold sores around the mouth, and HSV-2 which causes sores around your dick and butt. Glandular Fever is also a member of this family of viruses. There’s no cure for Herpes, although antiviral treatments can help to keep outbreaks under control.
Hepatitis
There’s three different types of Hepatitis – Hep A, Hep B, and Hep C. Hep A is found in faeces and Hep B is found in pretty much all bodily fluids. There is a vaccine that will protect you against both Hep A and Hep B. There’s no vaccine against Hep C – it’s primarily a blood-related risk if you’re injecting drugs, but can be transmitted through cum. Hepatitis can be treated, but if left untreated it can cause long-term damage to your liver.
MCV
This stands for Molluscum Contagiosum Virus. MCV is a skin infection that’s caused by a virus – the virus is transmitted through physical contact. The virus only lives in the outer layer of skin and causes small bumps or lesions on the skin. Treatment is relatively straightforward.
Scabies
Scabies is a skin disease caused by a tiny parasitic mite that lives just under the surface of your skin. Scabies can be spread by any form of skin-to-skin contact and can also be caught from infested clothing, sheets or towels. An infestation by the parasite causes a red, bumpy and very itchy rash in the affected areas. Treatment is readily available.
Syphilis
This is a bacterial infection that can be transmitted through all forms of sexual activity. Using a condom will help prevent the transmission of Syphilis when fucking or being fucked. Symptoms can be difficult to detect, but your routine testing will pick it up. Detected early, it is easily treated with antibiotics.