Background
Following evidence of doxycycline postexposure prophylaxis (doxyPEP) efficacy to prevent chlamydia, gonorrhea and syphilis among men and transgender women who have sex with men, Public Health – Seattle & King County (PHSKC) released provider guidance in June 2023. We utilized data from PHSKC’s annual Pride Survey to assess changes in knowledge and self-reported doxyPEP use among sexually active respondents from King County in the year after release of local guidelines.
Methods
The Pride Survey is an annual, cross-sectional, online, anonymous, sexual health survey open to Washington residents who identify as LGTBQ+. The survey is advertised at Pride events and through social media, local LGBTQ+ news sources, and posters at LGBTQ+ venues in the greater Seattle area throughout the summer. Among the subset of respondents from King County, we used descriptive statistics to compare doxyPEP knowledge, interest, and use in 2023 versus 2024 among transgender women and gay, bisexual, and other men who have sex with men (GBMSM) who reported sex with a male-identifying partner in the past year. Given the historic and ongoing impacts of structural racism on healthcare access and engagement, we also assessed doxyPEP knowledge and use by self-reported race and ethnicity among 2024 survey respondents.
Results
A total of 232 respondents in 2023 and 287 in 2024 were included in this analysis. Respondent characteristics were similar between years; when aggregated across years: 91% were HIV-negative, 45% were currently using PrEP and 14% reported an STI in the past year. Knowledge of doxyPEP, self-reported use and interest in use among those who had not reported doxyPEP in the last 12 months are presented by year in the Table. DoxyPEP knowledge and use increased, especially among GBMSM using PrEP; knowledge of doxyPEP was lower among trans women compared to GBMSM. DoxyPEP knowledge, use and interest was qualitatively similar by self-reported race and ethnicity. Nearly all (90%) respondents reported getting doxyPEP from their healthcare provider.
Conclusions
Among King County Pride Survey respondents, knowledge and use of doxyPEP use increased among GBMSM from 2023 to 2024, with the highest knowledge and use among GBMSM using PrEP. Knowledge of doxyPEP was lower among 2024 respondents who identified as transgender women, representing an important opportunity for both community and provider education to improve knowledge of and access to doxyPEP in this priority population.