“The morning-after pill for STIs”: everything you need to know

You’ve probably heard of DoxyPEP (or maybe you haven’t) without really knowing what it is. Well, the good news is that DoxyPEP isn’t what it sounds like: a management consulting firm that specialises in doxxing. The really good news is that it’s a potentially game-changing way of preventing bacterial sexually transmitted infections (STIs). The catch, sadly, is that it’s so new that it isn’t widely available in the UK yet. But in the meantime, here’s everything you need to know about DoxyPEP and how to get hold of it.

OK, deep breath… DoxyPEP stands for ​“doxycycline post-exposure prophylaxis”. This may sound complicated, but all it means is that after having condomless sex you can take a dose of doxycycline – a common antibiotic – to prevent certain STIs from developing.

Doxycycline has been prescribed by doctors for more than 50 years, often for chest and skin infections, but using it to prevent STIs is a much more recent innovation. Because DoxyPEP hasn’t been authorised in the UK yet, it isn’t available on the NHS for that purpose, so it’s still a little under the radar here. However, there have been highly promising trials in the US and France. ​“Think of it as a morning-after pill for STIs,” says Ian Howley, CEO of health and wellbeing charity LGBT Hero.

A 2022 study that provided trans women and MSM (men who have sex with men) in the US with DoxyPEP found that it cut the risk of contracting syphilis, gonorrhoea and chlamydia by about two-thirds. This is obviously excellent, but do keep in mind that DoxyPEP is a bacterial medication, i.e. it doesn’t protect you from HIV, Hep B, monkeypox or other viral infections.

Literally anyone who has had unprotected sex and is worried about STIs. Though a 2023 DoxyPEP trial among cis women in Kenya didn’t find that it led to significant reductions in STIs, the researchers reported that many participants may have skipped doses. ​“It’s also possible that high rates of gonorrhoea resistance and anatomical differences contributed to the disappointing results,” says Matthew Hodson, executive director of the HIV information charity Aidsmap.

Howley says that at present, DoxyPEP is ​“particularly” relevant to MSM and trans women ​“because the rates of syphilis, gonorrhoea and chlamydia can be quite high in these communities”.

Hodson says ​“DoxyPEP is generally safe” but points out that ​“some people do experience side effects such as diarrhoea and nausea from taking antibiotics”. If antibiotics do tend to give you a dodgy tummy, taking it with food may help.

“I often hear concerns raised about increased use of antibiotics leading to greater levels of drug resistance, but at this point the trial findings don’t bear that out,” says Hodson. He also points out that doxycycline is ​“already widely used” to treat everything from Lyme disease to sinusitis, so on a global scale, ​“any [future] use for STI prevention would be dwarfed by its existing use”.

There are no official figures, but anecdotal evidence suggests it is becoming more prevalent among gay and bisexual men. ​“We’re basically at the same point as when [HIV prevention drug] PrEP first became known in the UK – people are self-sourcing DoxyPEP because it isn’t available on the NHS [for this purpose], which isn’t ideal,” says Howley.

And because doctors almost certainly won’t tell you about DoxyPEP, some groups of MSM are spreading the word themselves. ​“A lot of the men using it at the moment are involved in the sex club and group sex scene and are sharing information among themselves through WhatsApp and Telegram groups,” says Howley.

Joey Knock, a 33-year-old cis gay man from London, tells THE FACE he has been taking DoxyPEP since autumn 2022. ​“When a friend told me about it, I thought it could work for me because I was getting chlamydia a lot,” he says. ​“It’s not the worst infection in the world but it’s annoying when you keep having to go for testing and treatment. And if you get it, it puts you out of action [sexually] for a week, which was having an impact on my social life.”

Knock says he now takes DoxyPEP ​“two or three times a month” after attending sex-centric queer club nights. ​“If I go into darkrooms on Friday and Saturday, I’ll take a dose on Sunday as it’s effective for up to 72 hours,” he says. ​“I only take it after group sex events; I don’t take it after hook-ups or threesomes at home, because I feel less at risk then. With one-on-one hook-ups, people are pretty much always traceable and I expect them to tell me if they have an STI.”

Medical experts recommend taking a 200mg dose of doxycycline (typically two 100mg pills) as soon as possible – and no later than 72 hours – after having sex. Try to avoid dairy products, antacids and multivitamins two hours beforehand, as these can affect absorption in your stomach.

“You can take it as often as every day when you’re having sex but don’t take more than two pills every 24 hours,” says Howley. ​“And if you are going to take doxyPEP, it’s best to consult your sexual health clinic, who can advise you better based on your personal circumstances.”

DoxyPrEP stands for ​”doxycycline pre-exposure prophylaxis”. Basically, instead of taking a dose of doxycycline after you have sex, you take it beforehand, though there’s been much less research into this approach.

“The idea is that people with a high likelihood of acquiring STIs take daily pills in the same way that PrEP is used to prevent HIV,” says Hodson. ​”And a small US study suggests this may be effective.”

Because it has yet to be authorised here, it does take a bit of moxie to get hold of doxy (sorry). ​“When PrEP for HIV wasn’t available on the NHS, many gay men self-sourced their supply online and the same is now happening with DoxyPEP,” says Hodson.

Knock says he normally uses ​“an online overseas supplier because it’s cheaper and you can buy in bulk”. On other occasions, he has self-administered by using leftover doxycycline that he was previously prescribed by a doctor to treat chlamydia. He also says that friends have bought doxycycline through the Boots and Superdrug online pharmacies by saying they need it to treat chlamydia.

Don’t hold your breath, boys. ​“The government has advised against using DoxyPEP until further research is done into how effective it is, so it’s probably going to be years before it’s available,” says Howley.

However, he also points out that the LGBTQ+ community has a long history of ​“having to fight” for sexual health medication – and rising to the challenge. HIV prevention drug PrEP has been available on the NHS since 2017 (first in Scotland, then in other UK regions) thanks to judiciously applied pressure from LGBTQ+ lobbying groups.

For now, though, Howley’s advice on behalf of LGBT Hero is clear and straightforward. ​“If you want to use DoxyPEP and plan on self-sourcing it, we highly recommend that you contact your sexual health clinic so they can monitor you and your health,” he says. ​“Otherwise, the best way to prevent STIs is to use condoms when you have sex.”