Doxycycline Postexposure Prophylaxis for STIs in Women — Uncertain Benefit, Urgent Need

This editorial discusses the uncertain benefit and urgent public health need for doxycycline postexposure prophylaxis (PEP) against sexually transmitted infections (STIs) in cisgender women. The discussion pivots on recent trial data (by Stewart et al.) showing no reduction in STI incidence among Kenyan women, despite promising results in men who have sex with men. Contributing factors include low drug uptake, preexisting tetracycline resistance, and low background syphilis rates. Author Jeanne Marrazzo highlights key issues:

Past doxycycline PEP studies showed benefit in MSM populations.

STI rates among women remain stubbornly high, with congenital syphilis reaching record levels in the U.S.

Biological differences (e.g., cervicovaginal drug levels vs. rectal tissue) may affect efficacy.

Social contexts, partner dynamics, and risk perception influence adherence and uptake.

The editorial calls for targeted biomedical trial designs in women that account for pharmacodynamics, behavior, and microbial resistance patterns.

Urges advancement of STI prevention beyond one-size-fits-all models, especially for underserved women at high risk.

This editorial discusses the uncertain benefit and urgent public health need for doxycycline postexposure prophylaxis (PEP) against sexually transmitted infections (STIs) in cisgender women. The discussion pivots on recent trial data (by Stewart et al.) showing no reduction in STI incidence among Kenyan women, despite promising results in men who have sex with men. Contributing factors include low drug uptake, preexisting tetracycline resistance, and low background syphilis rates. Author Jeanne Marrazzo highlights key issues:

Past doxycycline PEP studies showed benefit in MSM populations.

STI rates among women remain stubbornly high, with congenital syphilis reaching record levels in the U.S.

Biological differences (e.g., cervicovaginal drug levels vs. rectal tissue) may affect efficacy.

Social contexts, partner dynamics, and risk perception influence adherence and uptake.

The editorial calls for targeted biomedical trial designs in women that account for pharmacodynamics, behavior, and microbial resistance patterns.

Urges advancement of STI prevention beyond one-size-fits-all models, especially for underserved women at high risk.