The Morning-After Pill for STIs
My Experience on Doxy-PEP
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Doxy-PEP is a morning-after antibiotic that reduces the risk of chlamydia, gonorrhea & syphilis. I am not a doctor or therapist. I am presenting current data & my experience using Doxy-PEP. Info links under article.
It’s noon and I’m doomscrolling in the bathroom. My stomach has been fucked up for days, so I’m on the toilet again, looking up sexually transmitted infections. Just a few nights ago, I was rollin’ around in a notorious sex dungeon in Berlin. Now the Sunday scaries are setting in. What if I caught Giardia? I’m timezones away from my doctor in New Orleans. I’m in Europe for another week, then traveling to a wedding in Palm Springs, then a cross-country road trip to my parents’ house in the middle of Nowhere, New Mexico. An STI right now could be a mini-catastrophe. Never mind, it can’t be Giardia, that takes 1-2 weeks. What if it’s an antibiotic-resistant strain of The Clap? Could that give me diarrhea?? I keep scrolling. The bottle of Doxy-PEP peeks from my toiletry bag. A shame in the pit of my stomach. I shouldn’t have taken the Doxy and fuck around like I’m bullet-proof. I’m gonna spend this trip on the toilet.
Now mind you, I haven’t had a vegetable in days, I’m eating like a tourist, scarfing down schnitzels and sausages, washing them down with beers and shots of Jäger, doing drugs at raves, sleeping 4 hours a night and not drinking enough water. I’m also sensitive to antibiotics if I take them in the day. My stomach issues could be from literally any of those things, but my mind zeroed in on THE SEX. Even after two decades of working in Gay health and HIV activism, I can’t deprogram the fear I’m being punished for getting a lil’ wild on vacation. I make a deal with myself to stop the irrational Googling and for the next two days, I eat only vegetable soups and yogurt. My stomach recovers just fine. I take my next dose of Doxy-PEP before bed. No more issues. I try not to be hard on myself for my little freakout.
We are in an STI public health crisis. STIs have increased 30% over the last five years and syphilis is at its highest level in the last 70 years. It’s a perfect storm: the end of the lockdowns, wider access to PrEP and condoms becoming a historical footnote for many of us. Enter Doxy-PEP.
Doxy-PEP is a new morning-after pill that reduces the risk of chlamydia, gonorrhea & syphilis when taken up to 72 hours after condomless sex. It’s the first major intervention we’ve had for STIs since the vaccine for HPV 20 years ago. It’s not really new though; it’s just a low dose of antibiotics.
I first heard about Doxy-PEP after a sex party in San Francisco (of course). The next morning, my bestie casually took a pill and told me he was in a study for an antibiotic post-exposure prophylactic. Studies have shown that taking Doxy-PEP reduces your chance of getting syphilis and chlamydia by about two-thirds or 80% if you are a transgender woman or a man who has sex with men. Doxy-PEP reduced the risk of gonorrhea by about 55-60% but its effectiveness appears to depend on whether circulating strains already have doxycycline resistance.
200 mg of doxycycline is taken within 24 hours, but no later than 72 hours after condomless sex: oral, anal, or vaginal/front-hole sex where a condom is not used for the entire time. If you have sex again within 24 hours of taking doxycycline, you take another dose 24 hours after your last dose. You can take it as often as every day when you are having condomless sex but no more than 200 mg every 24 hours.
I work in Queer health activism as an artist and filmmaker. I’ve spearheaded outreach campaigns for HIV, against HIV criminalization, PrEP awareness and Mpox (monkeypox). So naturally, I posted about Doxy-PEP to my social media. I was not surprised by the engagement, concern or the Judge Judy tone of many DMs. So many of the talking points echoed PrEP when it was released 10 years ago, or even the Mpox vaccine last year.
The talking point usually goes something like this: “We’re all going to get in trouble because you whores don’t want to have safe sex and use condoms!”
First, condoms don’t prevent all STIs and I haven’t sucked dick with a condom since 1999 (it was strawberry flavored). Second, condomless sex is not always “unsafe” in the age of PrEP. We’ve attached a morality to condoms that was once needed for survival but can now be antiquated.
Now, there is good concern for antibiotic-resistant strains of disease. So I asked my friend, who is a prominent Queer doctor specializing in HIV prevention. He told me “Remind people that doxy and other antibiotics are given out like water by dermatologists for acne. Acne’s not an emergency. Syphilis is.”
Doxy is also used for Lyme disease and malaria. It’s interesting that it’s mostly when it involved Queer sex that we got into discussions of whether it should be used and how this affects the rest of the world. There seems to be a double standard when it comes to us. While they are valid questions, by immediately bringing up condoms or antibiotic-resistance, many folks are actually making a moral argument without realizing it, and not a public health one.
There is still much we don’t know about Doxy-PEP’s wide and long-term use, but Queer sexual health professionals seem optimistic about the numbers. Sometimes promising numbers is all we have in a public health crisis. A big lesson from HIV, Covid and Mpox is that we work with the current data then change course as we learn more. AIDS and the first drug cocktails taught us not all treatments are ideal or for everyone or permanent.
I’m not a doctor but I do know antibiotics wreck my system and it seems to me that one small dose as prevention instead of 7 days of heavy treatment and maybe spreading an STI before symptoms, is a better deal. My sex life also doesn’t warrant taking Doxy-PEP daily but I know many younger folks and sex-workers, for whom it could be a game-changer.
I was going to share my STI test results to report if it “worked” but that’s anecdotal evidence and not relevant. Doxy-PEP is not 100% effective. I will say I’m proud I tried it and grateful to have access. Like PrEP, vaccines, testing, and yes, condoms, it’s just another tool in my arsenal. I know my sexual freedom shouldn’t come with a price tag but it can come with a tax. Like Mpox and HIV, this is a chance for tough community discussions. Unpacking our knee-jerk reactions to Doxy-PEP may illuminate fears and shame we still carry.
Most of us were told early that sex could kill us, some of us were told we would deserve it. The result is that too many Queers either carry an irrational fear of STIs or an alarming disregard. There’s no way to separate that trauma from these conversations. Sometimes the mental benefits of these treatments can outweigh their physical risks. It’s a personal, delicate balance. The brutal truth is, deep down, many of us believe we don’t deserve all the tools if we’re being “sluts” and that shame can be more dangerous than any drug or bacteria. Doxy-PEP could be part of a long line of solutions to heal a deep communal wound.
Resources:
SF AIDS Foundation DoxyPEP Campaign
UCSF Doxy-PEP: Highly Effective, Minimal Drug Resistance
PBS Newshour DoxyPEP Segment (Video)
The Lancet on the DoxyPEP trials, 11.2022
CDC News on DoxyPEP (10.3.2023)
CDC report on rising STI rates 2021
Thanks for writing this. I particularly appreciated your comments about how antibiotics negatively affect your digestive system. I've been waiting to hear someone else mention these side effects. I felt as if I was the only one.
The stomach and intestinal bloating that doxy causes me have caused me to delete Doxy PEP from my arsenal against STI's.
For me, it is not uncommon to have condomless sex 2 or 3 times per week. Taking Doxy PEP, as prescribed would essentially mean taking it uninterrupted for sometimes long periods of time.
Have you heard of anybody taking this medicine on a sustained regular basis? What do they say about side effects? Do they become less over time?
Most of the gay men I know also have sex often enough to effectively need to take Doxy PEP daily on a sustained basis in order to take advantage of the STI defense that it promises.
It seems, to me, like Doxy PEP is being prescribed on the assumption that condomless sex is a rare isolated occurrence for which a consideration of side effects can be disregarded. As long as this assumption continues I think it alienates many sexually active people who have the highest risk of these STI's.
I'd love to know what you think