A public health ethics analysis of Doxy-PEP: arguments for and against – the ‘no’ case

Shreyas Iyer; Bridget Haire

doi:10.1071/SH24008

RESEARCH ARTICLE (Open Access)

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A public health ethics analysis of Doxy-PEP: arguments for and against – the ‘no’ case

Shreyas Iyer ^A and Bridget Haire

^B ^*

+ Author Affiliations

- Author Affiliations

^A UNSW School of Population Health, Nepean Hospital, Penrith, NSW, Australia. Email: Shreyas.Iyer@health.nsw.gov.au

^B Kirby Institute, School of Population Health, UNSW Sydney, Kensington, NSW, Australia.

^* Correspondence to: bhaire@unsw.edu.au

Handling Editor: Jason Ong

Sexual Health 22, SH24008 https://doi.org/10.1071/SH24008

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 doxycycline pre-exposure prophylaxis to prevent STIs in gay, bisexual and other men who have sex with men. 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 pre-exposure prophylaxis until further research is done. Thus, the use of doxycycline pre-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, doxycycline PEP, Doxy PEP, gay and bisexual men, men who have sex with men, public health ethics, STI prevention.

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