Selection of Neisseria gonorrhoeae ceftriaxone resistance using doxycycline post-exposure prophylaxis

There is increasing evidence that doxycycline post-exposure prophylaxis (doxy-PEP) is effective for preventing sexually transmitted infections among high-risk patients, particularly in patients using HIV pre-exposure prophylaxis.1–3 However, this benefit must be weighed against potential risks, including selection of antimicrobial resistance. Using whole genome sequencing data of 2375 gonococcal isolates from the 2018 Euro-GASP survey, Vanbaelen and colleagues4 showed that N gonorrhoeae tetracycline resistance-associated mutations and genes are often co-selected with additional antimicrobial resistance markers.