This prospective cohort study evaluated the real-world effectiveness of doxycycline postexposure prophylaxis use in reducing bacterial sexually transmitted infections (STIs) within a diverse urban sexual health program. Propensity-matched analyses showed significant STI reductions, particularly in rectal Chlamydia trachomatis infections, among early adopters. Uptake was disproportionately higher in non-Hispanic White individuals and those more engaged in care. Findings emphasize the need for targeted outreach to improve care engagement and equitable access to this STI prevention strategy. (Am J Public Health. Published online ahead of print August 14, 2025:e1-e5. https://doi.org/10.2105/AJPH.2025.308209).
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