Postexposure Doxycycline to Prevent Bacterial Sexually Transmitted Infections

作者：Anne F. Luetkemeyer, Deborah Donnell, Julia C. Dombrowski, Stephanie E. Cohen, Cole Grabow, Clare Brown, Cheryl Malinski, Rodney Perkins, Melody Nasser, Carolina B. López, Eric Vittinghoff, Susan Buchbinder, Hyman Scott, Edwin D. Charlebois, Diane V. Havlir, Olusegun O. Soge, Connie Celum · 发表于：New England Journal of Medicine · 年份：2023 · DOI：10.1056/nejmoa2211934 · 被引用次数：457 · 研究领域：Reproductive tract infections research、Syphilis Diagnosis and Treatment、Adolescent Sexual and Reproductive Health

BACKGROUND: Interventions to reduce sexually transmitted infections (STIs) among men who have sex with men (MSM) are needed. METHODS: (chlamydia), or syphilis in the past year. Participants were randomly assigned in a 2:1 ratio to take 200 mg of doxycycline within 72 hours after condomless sex (doxycycline postexposure prophylaxis) or receive standard care without doxycycline. STI testing was performed quarterly. The primary end point was the incidence of at least one STI per follow-up quarter. RESULTS: Of 501 participants (327 in the PrEP cohort and 174 in the PLWH cohort), 67% were White, 7% Black, 11% Asian or Pacific Islander, and 30% Hispanic or Latino. In the PrEP cohort, an STI was diagnosed in 61 of 570 quarterly visits (10.7%) in the doxycycline group and 82 of 257 quarterly visits (31.9%) in the standard-care group, for an absolute difference of -21.2 percentage points and a relative risk of 0.34 (95% confidence interval [CI], 0.24 to 0.46; P<0.001). In the PLWH cohort, an STI was diagnosed in 36 of 305 quarterly visits (11.8%) in the doxycycline group and 39 of 128 quarterly visits (30.5%) in the standard-care group, for an absolute difference of -18.7 percentage points and a relative risk of 0.38 (95% CI, 0.24 to 0.60; P<0.001). The incidences of the three evaluated STIs were lower with doxycycline than with standard care; in the PrEP cohort, the relative risks were 0.45 (95% CI, 0.32 to 0.65) for gonorrhea, 0.12 (95% CI, 0.05 to 0.25) for chlamydia, and 0.13 (95%...