Early uptake of doxycycline prophylaxis among MSM in Rome: Insights from a reference STI clinic

BackgroundPrompt doxycycline use (200 mg taken 24-72 hours after sexual activity, i.e., post-exposure prophylaxis, Doxy-PEP), effectively reduces chlamydia and syphilis acquisition in men who have sex with men (MSM) and individuals experiencing recurrent STIs. Considering the IUSTI Europe position statement and recent guidelines from the CDC, this study investigated the use of doxycycline to prevent STIs among MSM attendees of an STI/HIV center in Rome, Italy.MethodsFrom June 2024 to February 2025, an anonymous self-administered questionnaire was used to collect data on sexual behaviors, HIV status, HIV pre-exposure prophylaxis (PrEP), STI history, recreational substances, and doxycycline PrEP/PEP use. Logistic regression analyzed associations between Doxy-PEP/PrEP use and behavioral/clinical factors.ResultsTwo hundred and ninety MSM were enrolled. Among them, 9.3% reported using Doxy-PEP/PrEP, with nearly half accessing it without medical supervision. Multivariable analysis showed significant associations between doxycycline use and having ≥20 sexual partners, erectile drug use, and condomless anal sex.ConclusionsWhile doxycycline remains an uncommon choice for STI prevention among our attendees, its usage is linked to individuals engaging in sex with multiple partners. These findings highlight the urgency of national guidelines to address informal prophylactic antibiotic use and ensure supervised STI prevention strategies among individuals at elevated risk for bacterial STIs.