Doxypep: Miracle Cure or Public Health Hazard?

You may have already come across the term Doxypep—a combination of Doxycycline, an antibiotic, and post-exposure prophylaxis, meaning the use of medication after potential exposure to an STI or virus—on dating apps. Particularly in countries where antibiotics are widely prescribed, some queer men use Doxypep to protect themselves against chlamydia, syphilis, and gonorrhea. They do this by taking two doxycycline pills within 72 hours (preferably sooner) after potential exposure. When used in this way, the medication is not legally available in the Netherlands.

In the Netherlands, GPs are not very keen on prescribing antibiotics unless absolutely necessary.

Is Doxypep effective?

That depends on the research you look at, explains Mark van den Elshout, medical coordinator at GGD Utrecht Region:
"One study may show that it works well to prevent gonorrhea, while another does not. This is because gonorrhea develops resistance to antibiotics quickly. In some countries, including the Netherlands, gonorrhea is often already resistant to various antibiotics, including doxycycline, so Doxypep will usually not help to prevent a gonorrhea infection here."

In the Netherlands, general practitioners are reluctant to prescribe antibiotics unless absolutely necessary. "I think that's a very smart policy," Van den Elshout continues. "Countries where antibiotics are prescribed more freely face many challenges: it’s not a sustainable strategy for the future."

Chlamydia

Doxypep is effective in preventing chlamydia. However, the Dutch healthcare system increasingly does not view chlamydia as an STI.
"We’ve only been testing and treating chlamydia as an STI since the 1990s," Van den Elshout explains. "Back then, we thought chlamydia caused far more harm than it actually does. Chlamydia affects the body much less than gonorrhea does. Stories about infertility caused by chlamydia are also more nuanced than initially thought. Guys who’ve had both chlamydia and gonorrhea in their urethra know the difference: gonorrhea causes more pain and discharge, whereas chlamydia often goes unnoticed. For people with a penis, chlamydia rarely has serious consequences, and the body clears it up on its own."

Some infections, such as a sore throat or chlamydia, typically resolve on their own; in these cases, antibiotics generally only shorten the duration of the infection. Routine or improper use of antibiotics can lead to resistance, making some bacteria harder to treat, with significant public health consequences. Van den Elshout emphasizes:
"If you test twice a year and treat infections when they occur, you also give your body a chance to clear them on its own first. That’s a healthier way to manage infections. Even a single use of Doxypep disrupts the good bacteria in your gut. It’s better for your body to avoid it unless necessary."

Syphilis

In the Netherlands, Doxypep is ineffective for most cases of gonorrhea, and chlamydia is increasingly downplayed as an STI. Where Doxypep does work is in preventing syphilis, though there are caveats.
"With Doxypep, you can prevent 70 to 80% of syphilis infections, but syphilis isn’t very common in the Netherlands. Data from STI clinics show that gonorrhea affects 1 in 10 men who have sex with men, while syphilis affects only 1 in 50. Among PrEP users, that figure is even lower."

It is also difficult to ensure that Doxypep is used by the right people. "We need to seriously consider how much antibiotics we’re pumping into this community to prevent a single syphilis infection. According to recent calculations, ten people would need to take Doxypep for a year to prevent just one syphilis infection. That’s an enormous amount of antibiotics."

Vaccination: A Healthy and Effective Alternative

A healthier and more effective way to prevent STIs is through vaccination. Men who have sex with men can get free hepatitis B vaccinations at the GGD, and a hepatitis A vaccination is also recommended. Unfortunately, no vaccines currently exist for syphilis, chlamydia, or gonorrhea.

"Even though the likelihood of having contracted an STI decreases, make sure to keep getting tested."

Hanna Bos, spokesperson and physician at Soa Aids Nederland, advises caution when it comes to using Doxypep.
“With PrEP for HIV, we clearly promoted it as an important tool. I can imagine people now thinking, ‘Oh, there’s also a pill for STIs—how convenient.’ But within healthcare, the perspective is more nuanced,” she explains. A formal position on Doxypep is currently being developed and will be presented later this year.

“This is not just about antibiotic resistance; it’s also about the healthy population of bacteria you carry. Increasingly, we’re seeing signals that these healthy bacteria are important for your health. We still don’t fully understand the effects of antibiotics on these beneficial bacteria.”

Bos also points out that STI rates among men who have sex with men in the Netherlands are relatively manageable. “Here, we have good access to healthcare and regular testing. The numbers are rising slightly, but compared to other countries, we’re doing quite well.”

Do’s and Don’ts

Doxypep doesn’t appear to be the magical solution to prevent STIs. For those who choose to use Doxypep anyway, Mark van den Elshout has an important piece of advice:
“If you’ve used Doxypep, it can affect your test results, potentially leading to a false negative for syphilis. This means it might look like you don’t have syphilis when you actually do. Always inform your healthcare provider that you’ve used Doxypep when getting tested.”

“And definitely don’t buy doxycycline from your drug dealer,” adds Bos. “We’re hearing reports of people doing this. With online purchases, you also can’t be sure if the medication is reliable. Counterfeit drugs are quite common.”

Bos also emphasizes the importance of continuing to get tested:
“Even if your risk of contracting an STI is reduced, keep getting tested. You don’t want to be walking around with syphilis for a year.”

For more information, visit https://www.mantotman.nl/en/stds-hiv/preventing-stds/doxycycline-to-prevent-stds-after-sex

Text: Martijn Tulp

Image: Freepik