June 22, 2024

CDC Director Mandy Cohen on Wednesday visited Atlanta’s Ponce de Leon Center to personally make the announcement about the new preventative approach, and to encourage people who are at risk to talk to their doctors about using it.

“We really want to make sure that patients know that there is a new tool out there for them,” Cohen said. “We know that sexual health is so important to all folks. We know that all people deserve quality sexual health and to live healthy lives.”

The group of patients it’s recommended for may expand over time, if future studies show a benefit, said Dr. Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. For example, the doxy-PEP studies so far on cisgender women — a term used to describe women whose gender identity matches the sex they were assigned at birth — did not initially show a benefit, Mermin said, but “there were issues with the implementation of the trial that seemed to indicate that many of the participants did not take the (doxy-PEP) intervention.”

In recommending and approving drugs, federal agencies can’t open them up to everyone; they have to weigh the benefits against the risks. The downside for patients of taking doxycycline is that it can often cause indigestion or more severe side effects. But there’s a much bigger fear: that overuse of antibiotics generally will cause bacteria to grow resistant. If everyone uses doxycycline all the time, eventually it won’t be work for anyone.

Cohen spoke to reporters after touring the Ponce de Leon Center, which includes a clinic run by Grady Health System and founded 30 years ago to cope with the AIDS epidemic. The facility has already been using doxy-PEP for months, after CDC cracked the door open to the idea last year.

Doxycycline has been widely used for decades to kill bacteria and stop infections, from pneumonia to gum infections to some types of acne.

What’s new is that evidence has built in recent years showing that it works fast enough when taken as a morning-after pill to prevent certain sexually transmitted infections, or STI’s, in some patients.

The medical director at the Ponce de Leon Clinic, Dr. Jonathan Colasanti, said that the effects were obvious with syphilis and chlamydia, though less so with gonorrhea.

“You see the impact very, very quickly,” Colasanti said. “We have seen folks who, we’ll see them in clinic with STIs every month. And then you get them on this and all of a sudden it’s like, ‘Where’s Billy?’ We haven’t seen him because the medicines work.”

The CDC’s official recommendations come this week after three large, randomized, controlled trials showed that taking 200 mg of doxycycline within 72 hours after sex was reduced syphilis and chlamydia infections by more than 70%, and gonorrhea infections by about 50%.

Within the United States, Georgia ranked fifth for most cases of chlamydia and gonorrhea in 2022 in the U.S., and came in 20th for syphilis.

Asked whether some patients might see the new regimen as a permission slip to have unprotected sex with unsafe partners, the clinicians disagreed.

For one, thing they said, patients don’t tend to change their personal behavior based on medications.

They also emphasized that a patient’s risk of infection has a lot to do with infection levels in the surrounding community. If they’re high enough, having just one partner can still be risky. “Is that promiscuous? No. But the potential for infection is far higher,” Colasanti said.

“High quality evidence supports this strong recommendation,” CDC’s guidance document said.

It’s hard to say yet how important the development is. But based on some initial experience from early implementation in San Francisco, Mermin said, “I am hopeful that this will have a substantial effect on the STI epidemics.”

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