A public health ethics analysis of Doxy-PEP: arguments for and against – the ‘yes’ case

In September 2023, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine recommended consideration of doxycycline post-exposure prophylaxis to prevent STIs in gay, bisexual and other men who have sex with men. On 6 June 2024, the US Centers for Disease Control and Prevention added the intervention to its clinical guidelines. However, expanding antibiotic use carries the risk of propagating antimicrobial resistance among target STIs and non-target pathogens, prompting some experts to advocate withholding doxycycline post-exposure prophylaxis until further research is done. Thus, the use of doxycycline post-exposure prophylaxis is a question of whether the risk of antimicrobial resistance to the population is justified by the health benefits to gay, bisexual and other men who have sex with men. Here, we outline the public health ethics cases for and against this strategy.