Background
Doxycycline post-exposure prophylaxis (Doxy-PEP) is an effective tool for reducing bacterial sexually transmitted infection (STI) incidence among men who have sex with men (MSM). We sought to understand current rates of bacterial STIs (gonorrhea, chlamydia, syphilis) among MSM and generate Philadelphia’s first doxy-PEP continuum among MSM.
Methods
We used 2023 National HIV Behavioral Surveillance data collected through venue-based sampling among MSM in Philadelphia, with Philadelphia-specific local questions around the doxy-PEP continuum. We used Chi-square and Fisher’s exact tests to compare differences in demographics at each step of the doxy-PEP continuum. We also describe reported reasons for not wanting to take doxy-PEP.
Results
Of the 452 eligible respondents, 326 (72.1%) answered questions on doxy-PEP and were included in analyses. One in four (25.8%) MSM reported being diagnosed with a bacterial STI in the previous 12 months. Slightly more than one-third (n=119; 36.5%) of all MSM had heard of doxy-PEP, 12.6% had discussed doxy-PEP with a provider, and 5.5% had used doxy-PEP in the previous 12 months. Knowledge of doxy-PEP was significantly greater among those with more than a high school education and a recent gonorrhea or chlamydia diagnosis, compared to those with a high school education or less and those without a recent gonorrhea or chlamydia diagnosis, respectively. Discussing doxy-PEP with a provider was associated with having been recently tested for STIs (p=0.027), recently diagnosed with gonorrhea or chlamydia (p<0.001 for both), and being on HIV PrEP (p=0.047). Interest in doxy-PEP was significantly greater among non-Hispanic White MSM (81.5%) (compared to both non-Hispanic Black (63.5%) and Hispanic/Latino (52.4%) MSM), as well as those with a recent gonorrhea or chlamydia diagnosis. Among those uninterested in doxy-PEP, the most frequently reported reasons were not feeling like they need doxy-PEP (45.2%), needing more information (30.1%), and concern about side effects or feeling sick (11.8%).
Conclusions
Doxy-PEP awareness among MSM is low and few providers are discussing doxy-PEP as an option with their patients with recent bacterial STIs. Given the high level of interest in doxy-PEP among MSM, developing and distributing clear, culturally competent doxy-PEP guidance for providers has the potential for significantly increasing doxy-PEP awareness and uptake among MSM.