WHO issues first recommendation on Doxy-PEP for STI Prevention

The World Health Organization (WHO) has issued its first recommendation on the use of doxycycline post-exposure prophylaxis (PEP)-commonly referred to as doxyPEP-for the prevention of bacterial sexually transmitted infections (STIs) among men who have sex with men and transgender women.

The new recommendation, issued following a WHO guideline development process, reflects growing evidence that doxycycline taken after sexual exposure can reduce the risk of syphilis and chlamydia, and may also reduce gonorrhoea in some settings. These infections continue to rise in many regions worldwide, disproportionately affecting key populations.

“This new WHO recommendation marks an important step forward in expanding STI prevention options,” said Dr Tereza Kasaeva, Director of WHO’s Department for HIV, TB, Hepatitis & STIs. “WHO encourages countries and partners to work together to scale up implementation of this recommendation to ensure that these important key populations at increased risk can benefit from evidence-based prevention options”. WHO emphasizes that implementation should be part of a comprehensive sexual health approach, prioritize people with recent or recurrent STIs, particularly syphilis, and include context-appropriate monitoring of antimicrobial resistance.

Under WHO’s Global Health Sector Strategies on, HIV, viral hepatitis and STI’s, and commitments made in United Nations Political Declarations on HIV/AIDS and Universal Health Coverage, countries have committed to strengthening integrated prevention and expanding access to essential sexual health services. Despite these efforts, rates of STIs continue to increase in many settings. Men who have sex with men and transgender women remain among the populations often disproportionately affected.

Key drivers of these trends include limited prevention options beyond condoms, barriers to accessing comprehensive services, persistent stigma and discrimination, and weak integration of STI prevention within HIV and broader health programmes.

Next steps

• WHO will promote and support operationalization of the recommendation in countries through a series of webinars. Updates will also be shared through WHO’s Knowledge Sharing Platform.
• National STI programmes and other stakeholders are encouraged to consult WHO before introducing doxycycline PEP in line with the new guidance.
• The full guideline including evidence summaries and evidence-to-decision tables developed using the GRADE approach, will be published on the WHO website in the coming months and incorporated in the consolidated WHO STI guidelines. This includes a slide deck featuring a high-level summary of the guideline, including key messages and implementation considerations.