In this episode of The Good GP, host Karin Sekhon is joined by Dr Christine Dykstra, a specialist sexual health physician at Royal Perth Hospital and Sexual Health North. They discuss the emerging topic of doxycycline post-exposure prophylaxis (Doxy-PEP) for the prevention of bacterial sexually transmitted infections (STIs).

Dr Dykstra provides an overview of Doxy-PEP, describing it as the use of 200 mg doxycycline taken within 24 (but up to 72) hours after at-risk sexual contact, primarily to reduce the risk of bacterial STIs such as syphilis and chlamydia in target populations. The emerging gonococcal resistance to tetracyclines issue was also addressed.

Focusing on identifying appropriate candidates for Doxy-PEP, with current data supporting its use predominantly in gay and bisexual men and trans women at high risk—particularly those who have had syphilis or two bacterial STIs in the past year.

They also discussed the potential risks, primarily antimicrobial resistance, and the importance of patient education and regular STI testing as part of safe Doxy-PEP prescribing.

Dr Dykstra also discusses the level of awareness and uptake of Doxy-PEP in Australia, which remains low, and reinforces the importance of clinician engagement in providing accurate information and safe prescribing for those who may benefit.

Links & Resources:

• ASHM Decision Making Tool (March 2025): https://ashm.org.au/wp-content/uploads/2025/04/WEB-DoxyPEP-DMT-March-2025-Update.pdf
• ASHM 2023 Concensus Statement: https://ashm.org.au/initiatives/doxy-pep-statement/
• NSW Health Decision aid for consumers: https://www.health.nsw.gov.au/sexualhealth/Pages/doxy-pep-tool.aspx
• Recent study about acceptibility of DoxyPEP in Australia: https://pmc.ncbi.nlm.nih.gov/articles/PMC11723483/

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