Doxycycline Postexposure Prophylaxis and Bacterial Sexually Transmitted Infections Among Individuals Using HIV Preexposure Prophylaxis

作者：Michael W. Traeger, Wendy A. Leyden, Jonathan E. Volk, Michael J. Silverberg, Michael A. Horberg, Teaniese L. Davis, Kenneth H. Mayer, Douglas Krakower, Jessica G. Young, Samuel M. Jenness, Julia L. Marcus · 发表于：JAMA Internal Medicine · 年份：2025 · DOI：10.1001/jamainternmed.2024.7186 · 被引用次数：49 · 研究领域：HIV/AIDS Research and Interventions、Reproductive tract infections research、Pneumocystis jirovecii pneumonia detection and treatment

Importance: Doxycycline postexposure prophylaxis (doxyPEP) has been shown to decrease the incidence of bacterial sexually transmitted infections (STIs) among people assigned male sex at birth in clinical trials, but data from clinical practice are limited. Objective: To describe early uptake of doxyPEP and evaluate changes in STI incidence following doxyPEP initiation. Design, Setting, and Participants: This retrospective cohort study of adults (aged ≥18 years) dispensed HIV preexposure prophylaxis (PrEP) at Kaiser Permanente Northern California during November 1, 2022, to December 31, 2023, examined electronic health record data to compare HIV PrEP users dispensed and not dispensed doxyPEP and rates of bacterial STIs before and after starting doxyPEP. Individuals were followed up from their first recorded STI test on or after November 1, 2020, until December 31, 2023, or discontinuation of health plan membership. Exposure: Pharmacy dispensing data were used to define doxyPEP recipients. Main Outcomes and Measures: Demographic and clinical characteristics were compared between individuals dispensed and not dispensed doxyPEP. Primary outcomes were incident chlamydia, gonorrhea, or infectious syphilis measured as quarterly STI positivity (proportion of individuals testing positive at least once per quarter). Among doxyPEP recipients, rate ratios (RRs) compared mean quarterly STI positivity from 24 months before to 12 months after starting doxyPEP. In an exploratory analysis, ST...