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RESEARCH ARTICLE (Open Access)

A public health ethics analysis of Doxy-PEP: arguments for and against – the ‘yes’ case

Sam Templeman B and Bridget Haire https://orcid.org/0000-0002-0657-9610 A *
+ Author Affiliations
- Author Affiliations

A Kirby Institute and School of Population Health, UNSW Sydney, Sydney, NSW, Australia.

B UNSW School of Population Health, Sydney, NSW, Australia. Email: samt119@hotmail.com

* Correspondence to: bhaire@unsw.edu.au

Handling Editor: Jason Ong

Sexual Health 22, SH24013 https://doi.org/10.1071/SH24013
Submitted: 23 January 2024  Accepted: 2 July 2025  Published: 22 July 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

In September 2023, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine recommended consideration of doxycycline post-exposure prophylaxis to prevent STIs in gay, bisexual and other men who have sex with men. On 6 June 2024, the US Centers for Disease Control and Prevention added the intervention to its clinical guidelines. However, expanding antibiotic use carries the risk of propagating antimicrobial resistance among target STIs and non-target pathogens, prompting some experts to advocate withholding doxycycline post-exposure prophylaxis until further research is done. Thus, the use of doxycycline post-exposure prophylaxis is a question of whether the risk of antimicrobial resistance to the population is justified by the health benefits to gay, bisexual and other men who have sex with men. Here, we outline the public health ethics cases for and against this strategy.

Keywords: antimicrobial resistance, bacterial STIs, Doxy PEP, doxycycline PEP, gay and bisexual men, men who have sex with men, public health ethics, STI prevention, syphilis.

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