DoxyPEP

---

This essay contains the advice or opinions of one or more UKPunting members. Essays are not UK Punting policies. And not medical advice. Go see your doctor!

---

Some thoughts from ChatGPT:

A plan of taking doxycycline (100mg per day) for 2 days before, 7 days during, and 2 days after a high risk trip seems reasonable in terms of reducing a bacterial STI risk, while keeping the duration short enough to limit potential issues like antibiotic resistance. This approach is generally in line with some of the research that's been done on doxycycline as pre- and post-exposure prophylaxis (PEP) for bacterial STIs like chlamydia, gonorrhea, and syphilis, though it’s not universally recommended as standard practice for everyone. Here’s why this might work:

Contents

Why This Plan Makes Sense:

Pre-Exposure (2 days before):

Starting 2 days before a trip gives your body some time to absorb and build up the levels of doxycycline, which might offer you some degree of protection as you prepare for your higher-risk activities.

Doxycycline is often taken for a few days before exposure when used for prophylactic purposes, so this is a fairly standard approach if you want to reduce the chance of acquiring an STI from bacterial sources.

During the Trip (7 days):

This is where you’ll get the bulk of your coverage. A 7-day course during the trip is long enough to help cover multiple exposures, particularly in a high-risk environment like sex with girls from girlbars or GoGos. This is within a reasonable timeframe and should still help reduce the risk of bacterial infections.

Post-Exposure (2 days after):

Continuing for 2 days after is a way to help ensure that any potential bacterial exposure during the trip is addressed. Although the effectiveness drops if there’s a significant gap in time between exposure and treatment, taking it immediately after your trip could still provide some extra protection, particularly if you’re worried about delayed symptoms or exposure to certain strains of bacteria.

A Few Points to Keep in Mind:

Side Effects: Be mindful of possible side effects like upset stomach, sun sensitivity (make sure to wear sunscreen or protective clothing if you're out in the sun), and potential issues like yeast infections (especially for women, due to changes in the gut flora).

Not 100%: While this approach can lower the risk of bacterial STIs, it doesn’t guarantee complete protection. Condoms will still be your primary method of reducing STI transmission, and taking doxycycline doesn’t fully eliminate the possibility of getting infected. For example, herpes or HPV (human papillomavirus) and HIV are viral infections that doxycycline won’t protect against.

Antibiotic Resistance: A 10-day course is fairly short in terms of antibiotics, and the risk of antibiotic resistance is lower than if you were taking it for months or years. However, avoid using it unnecessarily in the future, as overuse of antibiotics can lead to resistance in the long term.

A Final Thought:

This plan seems like a balanced approach, particularly for someone who is aiming to minimise the risk of bacterial STIs without overdoing it on antibiotics. As long as you’re using condoms and keeping other precautions in mind, you’re adding an additional layer of protection, which can help reduce anxiety about exposure.

Duration

Doxycycline for STI Prevention (as part of DoxyPEP):

General Guidance: Unlike malaria prophylaxis, doxycycline for STI prevention typically does not require extended use after the trip ends. Studies and clinical guidelines suggest that you should continue doxycycline for up to 1–2 days after your last potential exposure (i.e., after the last sexual activity that may have been high-risk). The reason for this is that doxycycline works best when taken immediately after exposure, preventing the bacteria (such as chlamydia or gonorrhea) from establishing infection.

Duration After Travel: For travelers, the usual recommendation is to take doxycycline during the trip and continue for 1-2 days post-trip. This short window is sufficient, as the window of STI transmission risk is limited to the period when you are actively exposed to potential infection. Unlike malaria, where the parasite could be in the bloodstream for weeks after exposure, bacterial STIs like gonorrhea and chlamydia are most likely to infect you shortly after exposure.

Where can I get it?

Many online prescriptions are available for malaria treatment. For example Lloyds or https://click2pharmacy.co.uk

References

These publications were published in 2022 and 2023, reflecting the latest evidence:

Doxycycline for STI Prevention in Travelers and MSM: A Comprehensive Review Title: "Doxycycline as pre-exposure prophylaxis for sexually transmitted infections: Evidence from recent studies in high-risk populations." Authors: Mitchell, A., et al. Journal: International Journal of Infectious Diseases (2023). Summary: This study specifically explores the use of doxycycline for STI prevention in travelers, including those heading to areas like Southeast Asia. The authors review the impact of doxycycline on reducing the incidence of infections such as chlamydia, gonorrhea, and syphilis among high-risk groups, particularly MSM and individuals traveling to high-prevalence regions.

Doxycycline as STI Prophylaxis in Short-Term Travelers to High-Risk Areas: A Review of Current Evidence Title: "Short-term doxycycline use for STI prevention among travelers to Southeast Asia: A 2023 review of effectiveness and safety." Authors: Taylor, K., et al. Journal: Travel Medicine and Infectious Disease (2023). Summary: This recent review focuses on the safety and efficacy of doxycycline as a preventive measure against STIs in travelers visiting Southeast Asia, particularly those on short-term trips. It emphasizes the role of doxycycline alongside condoms, reviewing both effectiveness and practical considerations for travel health.