"It's Been a Very Liberating Experience": Doxycycline Postexposure Prophylaxis for Sexually Transmitted Infection...

Pleasure is a key component in sexual decision making. Doxycycline postexposure prophylaxis (doxy-PEP) is a novel intervention for sexually transmitted infection prevention for men who have sex with men (MSM) that may influence sexual experiences. Using the Sexual Health Model, we assessed whether doxy-PEP use influences intimacy and sexual pleasure among MSM.

From November 2021 to December 2022, we conducted individual interviews with MSM living with and without HIV enrolled in a clinical trial of doxy-PEP (NCT03980223). Participants were purposively sampled to capture a range of doxy-PEP use frequency. Interviews explored how doxy-PEP influenced sexual health and decision making, pleasure, intimacy, and relationships. Interview transcripts and debrief reports were thematically analyzed.

We interviewed 43 DoxyPEP trial participants, of whom the median age was 38 years (interquartile range, 34-46 years), 63% identified as White, 18% as Black, and 38% as Hispanic. Nineteen (44%) were living with HIV. Participants reported that doxy-PEP use improved their quality of life by providing peace of mind and resulted in more enjoyable sex experiences and increased intimacy. Participants felt that doxy-PEP provided freedom to choose about condom use and selection of partners, and supported communication with sexual partners about sexually transmitted infection prevention. These positive experiences with doxy-PEP were similar in men living with and without HIV.

Men who have sex with men reported that doxy-PEP use improved their sexual pleasure and intimacy with partners. Recognizing these positive aspects of doxy-PEP is essential for tailoring messaging and counseling about doxy-PEP and could motivate doxy-PEP use.