Drop in Syphilis Cases as Gay Men Turn to doxyPEP
The CDC reports that syphilis diagnoses have decreased among gay and bisexual men, which may be due to increased use of doxyPEp.
A new report from the Centers for Disease Control and Prevention (CDC) finds that the sharp and drastic increases in the number STI diagnoses seen following the end of COVID-era lockdowns appear to have slowed.
In 2023, over 2.4 million cases of syphilis, gonorrhea, and chlamydia were diagnosed and reported, with 1.6 million chlamydia cases, 209,000 cases of syphilis, and over 600,000 cases of gonorrhea.
But the number of STIs decreased nearly 2% from 2022 to 2023.
The report reveals that there was a 7.2% decrease in gonorrhea diagnoses in 2023, and a less than a 1% change in chlamydia, indicating that the infection rate has stabilized.
Syphilis was more mixed — overall, there was a 1% increase in all stages of syphilis, but much of that increase was driven by a 12% increase in the rate of cases of unknown or later-stage syphilis (meaning people were infected years ago), as well as 3,882 cases of congenital syphilis (transmitted from pregnant mother to infant), including 279 stillbirths or infant deaths.
At the same time — in what many health experts are hailing as good news, there was a 10% decrease in diagnoses of primary- and secondary-stage syphilis, with only 53,000 cases reported.
The report found that the decrease in primary- and secondary-stage syphilis was chiefly driven by a 13% decrease in diagnoses among gay and bisexual men, who have historically accounted for nearly half of all infections.
As reported by the Detroit News, the decrease in syphilis among sexual-minority men marks the first drop since the CDC began reporting data for that subgroup in the mid-2000s.
Infectious disease experts said they believed that the reversal in syphilis diagnoses among gay and bisexual men was due to doxyPEP, a prevention protocol in which a person takes one 200-milligram tablet of doxycycline within 72 hours of condomless sex.
In recent years, three randomized controlled trials showed a 70% reduction in chlamydia and syphilis infections and a 50% reduction in gonorrhea infections among gay and bisexual men and transgender women who took doxyPEP.
San Francisco’s Public Health Department was the first to recommend doxyPEP for those populations in October 2022, after which the CDC also began recommending the treatment. Since then, health departments in other large cities have begun pushing doxyPEP as a disease-prevention strategy, much in the same way they have promoted pre-exposure prophylaxis, or PrEP, as a medical intervention to avoid HIV infection and reduce the number of new HIV cases.
A study published in the journal Sexually Transmitted Diseases found that San Francisco’s promotion of doxyPEP was linked to a decline in STIs among local men. Another study set to be published in next month’s edition of the journal reveals that doxyPEP may be growing in popularity as a disease prevention protocol, with half of 900 gay and bisexual men — who were recruited through hook-up apps — had heard of doxyPEP and were interested in pursuing the treatment.
Experts had hoped that success among the LGBTQ community might offer guidance on how to combat the spread of STIs among cisgender women. A study of doxyPEP among cisgender women in Africa failed to show efficacy, but there is currently an ongoing trial examining how effective the treatment is in U.S. women.
In July, researchers at a global HIV conference in Munich presented the findings of a study examining the use of doxyPrEP, a prevention method in which individuals take 100 milligrams of doxycycline daily prior to condomless sex, among gay and bisexual men in Canada and female sex workers in Japan.
The initial findings of that study appeared to demonstrate that doxyPrEP’s efficacy was comparable to doxyPEP in terms of preventing STIs.
Research continues regarding whether the use of doxycyline — which is typically used to treat people already infected with gonorrhea or chlamydia — as a prevention method may lead to drug-resistant strains of STIs. Thus far, however, researchers have not found evidence to suggest that it is contributing to drug resistance.
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