The United States is expected to soon recommend adding a new weapon to the arsenal against sexually transmitted infections: an antibiotic developed decades ago that has been transformed into a preventive pill.
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Clinical studies have shown that doxycycline, when taken without a condom after sex, significantly reduces the risk of infection with three diseases: chlamydia, gonorrhea and syphilis.
The most important US federal health authority, the CDC (Centers for Disease Control and Prevention), is responsible for deciding on new recommendations. This must take into account the need to contain epidemics that are affecting millions of Americans, but also the risk of increasing resistance to the antibiotic.
“Innovation and creativity are important to public health, and we desperately need new tools,” CDC official Jonathan Mermin told AFP.
These recommendations, due to be released this summer, are likely to only target the most vulnerable groups: gay men or transgender women with previous infections.
But as word gets around, some doctors are already prescribing the antibiotic for this purpose.
Malik, a 37-year-old Washington resident who declined to give his last name, has already taken doxycycline for prevention on two occasions on the advice of his doctor, according to risky reports – including one where a partner had failed to notify him of his withdrawal from his condom.
epidemics are increasing
Cases of these three bacterial infections have been rising for a decade, reaching 2.5 million in the United States in 2021.
First, because mechanically, the more infections there are, the more they are transmitted.
But also because condoms are being used less and less since the introduction of Prep – a drug to prevent AIDS.
Additionally, people receiving Prep should be tested every three months to detect more infections.
Doxycycline has been shown to be effective in three out of four clinical studies conducted.
“We saw a two-thirds decrease in sexually transmitted infections,” Annie Luetkemeyer, who led an American trial, told AFP.
The latter was conducted on 500 men who had sex with other transgender men and women.
It was found that the effectiveness against chlamydia and syphilis (-80% infections) is higher than against gonorrhea (-55%). Side effects were minor.
antibiotic resistance
However, increased access to doxycycline has also raised concerns that antibiotic resistance could develop, particularly in gonorrhea, whose bacteria are rapidly mutating.
However, initial analyzes are reassuring.
During the American clinical study, the researchers compared samples of this bacterium from infections that occurred despite treatment with doxycycline with samples from the untreated group.
The rate of resistant bacteria was certainly higher in the treated group, but that could simply mean that the antibiotic is less effective against that resistant strain, not that it caused it, explained Connie Celum, co-leader of this work. .
Also, because doxycycline could cut the number of infections by half, half as many people would need to be treated with the antibiotic (ceftriaxone) normally prescribed for gonorrhea. But doctors want to preserve the effectiveness of this drug.
More studies need to be done to understand the effects of doxycycline on other bacteria, such as those in the nose or gut.
“Additional tool”
Malik says he’s glad he was able to use doxycycline as a last resort, but wishes more men would agree to condom use. According to him, since moving to the US from South Asia, fewer men are interested in dating sites when he says he doesn’t want sex without that protection.
But according to Stephen Abbott, a Washington doctor who prescribes and uses doxycycline, it’s important to consider behavioral changes.
“I speak to patients and because I’m part of the prep community … I think the era of condom prevention is coming to an end,” he told AFP. AFP.
According to an official at a cultural organization in London, who testified on condition of anonymity, the noise about this new treatment spread quickly and he himself now buys doxycycline on the black market.
The 42-year-old wants the UK to adopt new recommendations too, he told AFP, so people are better informed, particularly about the dosages required.
For researcher Annie Lütkemeyer, doxycycline will not be the only answer to the epidemic of sexually transmitted diseases. The development of a vaccine against gonorrhea would still make a lot of sense.
“But I’m optimistic,” she said. “I think it’s an additional tool.”