Sexual health services in the UK are reporting soaring rates of gonorrhoea, chlamydia, and syphilis, and their data indicates that it’s men who have sex with men that are most at risk.
“There a combination of reasons why we’re seeing a rise in cases…” explains Ian Howley, chief executive of LGBT Hero – a national health and wellbeing charity. “There’s been less sexual health awareness messages over the last few years, and people are struggling to book an appointment to test for STIs – which has a knock on effect in terms of stopping the spread. There’s also the increase of comdomless sex due to PrEP, and we’re still in a hangover from the pandemic when people didn’t test and may have carried some STIs for longer than they would normally. All these factors are playing into a system where we are seeing a rise in STIs among men who have sex with men.”
Worryingly, under-resourcing of sexual health clinics in the UK is leaving people without the testing and treatment needed to contain and minimise the harm of STIs.
“Over the last few years, we’ve seen a decrease in funding for sexual health and HIV prevention…” says Ian Howley. “The government has big aims to end HIV by 2030 but it’s not showing that in how it funds sexual health services. Sexual health and HIV prevention is a not a one-size-fits-all approach and, in many ways, has become very medicalised and less about holistic wellbeing issues – such as tackling mental wellbeing issues that are linked to poorer sexual health. I feel that we’ve lost the community drive that used to exist – sexual health right now is very flat. A new approach is needed not just to make people aware about HIV and STIs but to allow people to have the best sex with the least amount of risk. Let’s put the sex back into the sexual health!”
With the UK’s health service increasingly unable to cope with demand, it seems that many men are turning to DoxyPEP to try and mitigate potential exposure to STIs.
What is DoxyPEP?
DoxyPEP refers to the use of Doxycycline – a broad-spectrum antibiotic.
Doxycycline is primarily used to treat infections caused by bacteria and is frequently used in the treatment of bacterial pneumonia and acne. However, always the innovators, the gays have discovered that taking Doxycycline after sex can help to prevent the acquisition of any STIs that your hook-up might be bringing to the party.
It’s referred to as DoxyPEP because the Doxycycline is being taken as a post-exposure prophylactic.
Doxycycline usually comes in capsule form and is taken orally.
“I think DoxyPEP could be an excellent way of tackling STIs in our community…” confirms Ian Howley. “However, it’s clear more research needs to be done to figure out the exact benefit this will have. From the research we do have, it’s clear that it has some benefit. Right now, this method has not been approved for use in the UK and many men are self-sourcing. It’s not ideal and I’d prefer if we could speed up this process as part of a trial similar to PrEP. DoxyPEP could be a real benefit to those who engage in group sex or have lots of different sexual partners.”
While the UK has not approved the use of DoxyPEP as a tool against STI transmission, the US Centers for Disease Control and Prevention has issued some proposed guidelines.
The general strategy that most people follow is to take a dose of Doxycycline as soon as possible after your sexual encounter – ideally within 24 hours. If you’re taking DoxyPEP more than 72 hours after your sexual encounter it’s probably too late to have significant benefit.
It’s important to remember that a Doxy PEP strategy isn’t going to protect you from all the STIs that you might encounter. While taking Doxycycline should give you some protection against STIs such as gonorrhoea, chlamydia, and syphilis, it won’t protect you against STIs such as HIV or Mpox, so keep up your PrEP schedule and get vaccinated.
You also need to be aware that DoxyPEP is not without side-effects. Antibiotics work by killing bacteria. Like most antibiotics, Doxycycline can’t distinguish between “good” and “bad” bacteria. That’s why an antibiotic such as Doxycycline will disrupt your digestive system – it will kill the “good” bacteria in your gut that are essential to healthy digestion. This bacteria is often referred to as your gut microbiome. How that might present itself is that you might experience diarrhoea or an upset stomach after taking Doxycycline. If you take Doxycycline frequently, your gut microbiome doesn’t get a chance to recover and you could compromise your digestive health.
Disclaimer – we’re not doctors, so don’t rely on us for medical advice. Speak to your local health service or your GP to ensure that taking Doxycycline is suitable for you. Availability of Doxycycline will vary depending on where you are in the world. As a general guide, Doxycycline normally requires a prescription from a doctor. It’s worth noting that not every medical professional will be in favour of you taking Doxycycline. There are concerns that the widespread use of antibiotics – particularly in a post-exposure-prophylactic scenario – can increase viral and bacterial resistance, making the antibiotics less effective for the general population. If you seek a prescription for Doxycycline, you may need to be assertive and transparent in explaining why you want to take the antibiotic.
How often should you test for STIs?
One of the reasons for higher rates of STI infection being reported among men who have sex with men is likely to be that the LGBTQ community are more likely to be engaged with a sexual health service and testing more regularly.
If you’re sexually active, you should – at a minimum – be testing for STIs at least every 12 months. If you’re having sex with multiple partners – that means if you’re active on the hook-up and dating apps and enjoying regular encounters – then you should be getting tested more frequently, such as every three to six months.
Testing is easy and straightforward. Home testing kits are widely available, sexual health clinics will generally provide free testing, or your local doctor will be able to complete the tests. If the tests return any positive results, then you’ll be treating early, getting on top of any problems, and ensuring that you’ve got the all clear to get back out there and get amongst it.
