A Review of Doxycycline Post-Exposure Prophylaxis and Its Implications for Antimicrobial Resistance and the Human Microbiome

Molina JM, Ghosn J, Béniguel L, Matta M, Pialoux G, Cua E, et al. Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial. Lancet Infect Dis. 2018;18:308–17.

Article  CAS  PubMed  Google Scholar 

Bachmann LH, Barbee LA, Chan P, et al. CDC clinical guidelines on the use of doxycycline postexposure prophylaxis for bacterial sexually transmitted infection prevention, United States, 2024. MMWR Recomm Rep. 2024;73(No. RR-2):1–8.

Article  PubMed  PubMed Central  Google Scholar 

European Centre for Disease Prevention and Control. EpiPulse: the European surveillance portal for infectious diseases. Stockholm: ECDC; 2021. https://www.ecdc.europa.eu/en/publications-data/epipulse-european-surveillance-portal-infectious-diseases

Molina JM, Bercot B, Assoumou L, Rubenstein E, Algarte-Genin M, Pialoux G, et al. Doxycycline prophylaxis and meningococcal group B vaccine to prevent bacterial sexually transmitted infections in France (ANRS 174 DOXYVAC): a multicentre, open-label, randomised trial with a 2 × 2 factorial design. Lancet Infect Dis. 2024;24(10):1093–104. https://doi.org/10.1016/S1473-3099(24)00236-6.

Article  CAS  PubMed  Google Scholar 

Bolan RK, Beymer MR, Weiss RE, et al. Doxycycline prophylaxis to reduce incident syphilis among HIV-infected men who have sex with men who continue to engage in high-risk sex: a randomised, controlled pilot study. Sex Transm Dis. 2015;42:98–103.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Grennan T, Mohammed S, Edward J, Tattersall T, Gupta AK, Seto J, et al. A pilot, randomised controlled trial of dual daily HIV and sexually transmitted infection pre-exposure prophylaxis using tenofovir disoproxil fumarate/emtricitabine and doxycycline in gay, bisexual, and other men who have sex with men and transgender women: the DuDHS study. Clin Infect Dis. 2025;30:ciaf043. https://doi.org/10.1093/cid/ciaf043.

Article  Google Scholar 

Abe S, Mizushima D, Ando N, Kawashima A, Uemura H, Shibata S, et al. Doxycycline pre-exposure prophylaxis prevents sexually transmitted infections without affecting vaginal bacterial flora in female sex workers. JAC Antimicrob Resist. 2025;7(2):dlaf054. https://doi.org/10.1093/jacamr/dlaf054.

Article  PubMed  PubMed Central  Google Scholar 

Luetkemeyer AF, Donnell D, Dombrowski JC, et al. Postexposure doxycycline to prevent bacterial sexually transmitted infections. N Engl J Med. 2023;388(14):1296–306.

Article  CAS  PubMed  PubMed Central  Google Scholar 

La Ruche G, Goubard A, Bercot B, et al. Gonococcal infections and emergence of gonococcal decreased susceptibility to cephalosporins in France, 2001 to 2012. Euro Surveill. 2014;19:20885.

Article  PubMed  Google Scholar 

Reichert E, Grad YH. Effects of doxycycline post-exposure prophylaxis for prevention of sexually transmitted infections on gonorrhoea prevalence and antimicrobial resistance among men who have sex with men in the USA: a modelling study. Lancet Microbe. 2024;5(11):100926. https://doi.org/10.1016/S2666-5247(24)00168-X.

Article  PubMed  PubMed Central  Google Scholar 

Do K, Unemo M, Kenyon C, Hocking JS, Kong FY. Tetracycline-resistant Neisseria gonorrhoeae global estimates—impacts on doxycycline post-exposure prophylaxis implementation and monitoring: a systematic review. JAC Antimicrob Resist. 2025;7(4):dlaf120.

Article  PubMed  PubMed Central  Google Scholar 

Stewart J, Oware K, Donnell D, et al. Doxycycline prophylaxis to prevent sexually transmitted infections in women. N Engl J Med. 2023;389:2331–40.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Haaland RE, Fountain J, Edwards TE, Dinh C, Martin A, Omoyege D, et al. Pharmacokinetics of single dose doxycycline in the rectum, vagina, and urethra: implications for prevention of bacterial sexually transmitted infections. EBioMedicine. 2024;101:105037. https://doi.org/10.1016/j.ebiom.2024.105037.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Traeger MW, Leyden WA, Volk JE, et al. Doxycycline postexposure prophylaxis and bacterial sexually transmitted infections among individuals using HIV preexposure prophylaxis. JAMA Intern Med. 2025;185(3):273–81. https://doi.org/10.1001/jamainternmed.2024.7186.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Centers for Disease Control and Prevention. National overview of STIs in 2023. Atlanta (GA): Centers for Disease Control and Prevention; 2024 [cited 2025 Jul 3]. https://www.cdc.gov/sti-statistics/annual/summary.html.

British Association for Sexual Health and HIV. BASHH publishes UK-first guidelines on doxyPEP for the prevention of syphilis. London: BASHH; 2025 [cited 2025 Jul 5]. https://www.bashh.org/news/1686/bashh_publishes_ukfirst_guidelines_on_doxypep_for_the_prevention_of_syphilis/.

Kohli M, Medland N, Fifer H, Saunders BJ. BASHH updated position statement on doxycycline as prophylaxis for sexually transmitted infections. Sex Transm Infect. 2022;98(3):235–6. https://doi.org/10.1136/sextrans-2022-055425.

Article  PubMed  Google Scholar 

World Health Organization. Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. Geneva: WHO; 2012 [cited 2025 Feb 15]. https://iris.who.int/handle/10665/44863.

Haute Autorité de Santé. Doxycycline en prévention des infections sexuellement transmissibles bactériennes. Paris: HAS; 2025. Report No.: 2. https://www.has-sante.fr/jcms/p_3425026/fr/doxycycline-en-prevention-des-infections-sexuellement-transmissibles-bacteriennes.

De Scheerder M, Libois A, Van Praet J, Kenyon C. Doxy post-exposure prophylaxis for STI not endorsed by BREACH. Brussels: Belgian Research HIV Consortium Proceedings; 2023.

Google Scholar 

Chu VT, Glascock A, Donnell D, Grabow C, Brown CE, Ward R, et al. Impact of doxycycline post-exposure prophylaxis for sexually transmitted infections on the gut microbiome and antimicrobial resistome. Nat Med. 2024;3:1–1.

Google Scholar 

Rashid M-U, Panagiotidis G, Bäckström T, Weintraub A, Nord C. Ecological impact of doxycycline at low dose on normal oropharyngeal and intestinal microflora. Int J Antimicrob Agents. 2013;41:352–7.

Article  CAS  PubMed  Google Scholar 

Yaffe E, Relman DA. Tracking microbial evolution in the human gut using Hi-C reveals extensive horizontal gene transfer, persistence and adaptation. Nat Microbiol. 2020;5:343–53.

Article  CAS  PubMed  Google Scholar 

Mättö J, Maukonen J, Alakomi HL, Suihko ML, Saarela M. Influence of oral doxycycline therapy on the diversity and antibiotic susceptibility of human intestinal bifidobacterial population. J Appl Microbiol. 2008;105(1):279–89. https://doi.org/10.1111/j.1365-2672.2008.03792.x.

Article  CAS  PubMed  Google Scholar 

Truong R, Tang V, Grennan T, Tan DHS. A systematic review of the impacts of oral tetracycline class antibiotics on antimicrobial resistance in normal human flora. JAC Antimicrob Resist. 2022;4(1):dlac009. https://doi.org/10.1093/jacamr/dlac009.

Article  PubMed  PubMed Central  Google Scholar 

Hu Y, Yang X, Qin J, et al. Metagenome-wide analysis of antibiotic resistance genes in a large cohort of human gut microbiota. Nat Commun. 2013;4:2151. https://doi.org/10.1038/ncomms3151.

Article  CAS  PubMed  Google Scholar 

Wollein Waldetoft K, Sundius S, Kuske R, Brown SP. Defining the benefits of antibiotic resistance in commensals and the scope for resistance optimization. MBio. 2023;14(1):e01349-e1422.

Article  PubMed  Google Scholar 

Jo JH, et al. Alterations of human skin microbiome and expansion of antimicrobial resistance after systemic antibiotics. Sci Transl Med. 2021;13:eabd8077.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Skidmore R, Kovach R, Walker C, Thomas J, Bradshaw M, Leyden J, et al. Effects of subantimicrobial-dose doxycycline in the treatment of moderate acne. Arch Dermatol. 2003;139(4):459–64. https://doi.org/10.1001/archderm.139.4.459.

Article  CAS  PubMed  Google Scholar 

Ozolins M, Eady EA, Avery AJ, Cunliffe WJ, Po AL, O’Neill C, et al. Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial. Lancet. 2004;364(9452):2188–95.

Article  CAS  PubMed  Google Scholar 

Walker C, Preshaw PM, Novak J, Hefti AF, Bradshaw M, Powala C. Long-term treatment with sub-antimicrobial dose doxycycline has no antibacterial effect on intestinal flora. J Clin Periodontol. 2005;32:1163–9.

Article  CAS  PubMed  Google Scholar 

Walker C, Thomas J, Nangó S, Lennon J, Wetzel J, Powala C. Long-term treatment with subantimicrobial dose doxycycline exerts no antibacterial effect on the subgingival microflora associated with adult periodontitis. J Periodontol. 2000;71(9):1465–71. https://doi.org/10.1902/jop.2000.71.9.1465.

Article  CAS 

Comments (0)

No login
gif