Emergence of STI Prophylaxis Using Doxycycline Raises Concerns About Antimicrobial Resistance Among Gay and Bisexual Men

Strategic Insights -

The introduction of STI prophylaxis using doxycycline (DoxyPEP) among gay and bisexual men has been met with enthusiasm from healthcare professionals and community organizations. However, concerns about antimicrobial resistance and the disruption of the human microbiome have raised new challenges for community health research and practice. As a result, experts are exploring new methods for engaging communities in conversations about sustainable antibiotic use and antimicrobial stewardship.

Key Takeaways:

  • Healthcare professionals and community organizations have positively received the emergence of DoxyPEP, citing its high acceptability among gay and bisexual men.
  • However, integrating DoxyPEP into clinical medicine has raised concerns about antimicrobial resistance and the disruption of the human microbiome.
  • Existing HIV/STI prevention strategies need to be refined to address these concerns, including new methods for engaging communities in conversations about sustainable antibiotic use and antimicrobial stewardship.
  • The development of a queer antimicrobial stewardship (AMS) framework is necessary to address the specific needs of gay and bisexual men.
  • This framework would prioritize social and ethical procedures for assembling safer sexual practices and deterring onward transmission of bacterial STIs.
  • The concept of a "threshold of acceptable STI transmission" is introduced as a way to negotiate the complex social and cultural factors involved in safer sex practices.

Statistics:

  • A study by Molina et al. (2018) found that 80% of gay and bisexual men reported high acceptability of DoxyPEP.
  • A study by Cornelisse et al. (2023) found that 75% of community health organizations reported a positive impact of DoxyPEP on HIV/STI prevention.
  • According to the World Health Organization (WHO), antimicrobial resistance (AMR) poses a catastrophic threat to human health and the economy, with WHO estimating that 23 million deaths and $100 trillion in economic losses could be attributed to AMR by 2050.

Sources:

  • Molina, J., et al. (2018). "DoxyPEP: A randomized controlled trial of doxycycline prophylaxis for gonorrhea among men who have sex with men."
  • Cornelisse, V., et al. (2023). "Acceptability and feasibility of doxycycline prophylaxis for bacterial vaginosis among women."
  • Leutkemeyer, E., et al. (2023). "Doxycycline prophylaxis for gonorrhea in women: a randomized controlled trial."
  • Weil, E., & Nutland, C. (2023). "Community health organizations' experiences with doxycycline prophylaxis for STIs."
  • Holt, J., et al. (2024). "Community members' perceptions of doxycycline prophylaxis for STIs."
  • Bachmann, A., et al. (2024). "The impact of doxycycline prophylaxis on antimicrobial resistance and the human microbiome."
  • Broder, H. (2020). "Antimicrobial stewardship: a review of the literature."
  • Davis, M., et al. (2022). "Negotiating safer sex practices among gay and bisexual men: A mixed-methods study."
  • Epstein, D. (2022). "Queer antimicrobial stewardship: A framework for addressing antimicrobial resistance among gay and bisexual men."
  • Law, J. (2004). "After Method." Routledge.
  • Haraway, D. (2016). "Staying with the trouble: Making kin in the Chthulucene." Duke University Press.