Position Statement of the German STI Society (DSTIG) - Antibiotic STI Prevention with Doxycycline - Doxy-PEP/-PrEP Version 1.1

Sep 27, 2026

Uploaded by Stanley

Position Statement of the German STI Society (DSTIG) addresses preventive antibiotic use with doxycycline for STI risk reduction, focusing on the internationally used terms “Doxy-PrEP/-PEP” and clarifying the scope as “antibiotic STI prevention.” Evidence from randomized trials supports individual risk reduction for syphilis and chlamydia in MSM and some populations using HIV PrEP or with known HIV infection, while effectiveness is not demonstrated for cisgender women in at least one study. Benefits at population level are discussed as dependent on implementation, with risks including adverse effects and uncertainty about antimicrobial resistance and microbiome impacts. DSTIG recommends against broad implementation and suggests case-by-case post-exposure prophylaxis using Doxy-PEP.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages20

Reading Time50 min

AccessFree to download

Summary and recommendations

Introduction

Definitions and clarification of terminology

Doxy-PEP/-PrEP: Definition and modes of use

Differentiation from prophylactic treatment after exposure to confirmed syphilis

Differentiation from HIV pre-exposure prophylaxis (HIV PrEP)

Benefits and risks of antibiotic STI prevention

Benefits at the individual level

Benefits at the population level

Risks at the individual level

Risks at the population level

Epidemiology of syphilis and potential target groups

Surveillance and research

Approval status of doxycycline for STI prevention

Appendix

Overview of randomized controlled trials

References

Position Statement of the German STI Society (Deutsche STI Gesellschaft, DSTIG): Antibiotic STI Prevention with Doxycycline („Doxy-PEP“,„Doxy-PrEP“) Version 1.1, 26.07.2023 Ricardo N. Werner, Axel J. Schmidt, Anja Potthoff, Petra Spornraft-Ragaller, Norbert H. Brockmeyer; for the German STI Society (Deutsche STI-Gesellschaft, DSTIG) Content 1. Summary and recommendations ................................................................................................... 2 2. Introduction .................................................................................................................................... 4 3. Definitions and clarification of terminology .................................................................................. 5 3.1. Doxy-PEP/-PrEP: Definition and modes of use............................................................................ 5 3.2. Differentiation from prophylactic treatment after exposure to confirmed syphilis................... 5 3.3. Differentiation from HIV pre-exposure prophylaxis (HIV PrEP) .................................................. 5 4. Benefits and risks of antibiotic STI prevention .............................................................................. 6 4.1. Benefits of antibiotic STI prevention at the individual level ....................................................... 6 4.2. Benefits of antibiotic STI prevention at the population level ..................................................... 9 4.3. Risks of antibiotic STI prevention at the individual level........................................................... 10 4.4. Risks of antibiotic STI prevention at the population level......................................................... 12 5. Epidemiology of syphilis and potential target groups................................................................. 13 6. Surveillance and research............................................................................................................. 15 7. Approval status of doxycycline for STI prevention...................................................................... 15 8. Appendix ....................................................................................................................................... 16 8.1. Overview of randomized controlled trials................................................................................. 16 9. References..................................................................................................................................... 18 1. Summary and recommendations Given the rising incidence of syphilis over the past 20 years in Germany and other countries, particularly among men who have sex with men (MSM), there has been an increasing demand and body of evidence for the preventive use of the antibiotic doxycycline to avoid syphilis and other sexually transmitted infections (STIs) . The preventive intake of doxycycline before, during, or after sexual exposure is internationally referred to as "doxycycline Pre-or Post-Exposure Prophylaxis (Doxy-PrEP/-PEP) . " To promote terminological clarity, Doxy-PrEP/-PEP is referred to as "antibiotic STI prevention" in this position statement of the German STI Society (Deutsche STI-Gesellschaft, DSTIG) . The individual benefit of antibiotic STI prevention with doxycycline in terms of reducing the risk of syphilis and chlamydia infections has been convincingly demonstrated in several randomized controlled studies for MSM and transgender women using HIV PrEP or with known HIV infection. However, a Kenyan study did not prove effectiveness for cisgender women. Data on the population-level effects of antibiotic STI prophylaxis are currently only available from modelling studies, in which important factors such as a stratification by the number of sexual partners have been inadequately considered. To a large extent, the effects found in modelling studies, such a

FAQs

What does DSTIG define as “antibiotic STI prevention” in this position statement?

DSTIG refers to preventive doxycycline intake before, during, or after sexual exposure as “antibiotic STI prevention,” using the terms “Doxy-PrEP/-PEP” for the underlying concept.

What benefits does the statement attribute to doxycycline-based STI prevention?

Randomized studies show convincing individual-level risk reduction for syphilis and chlamydia for MSM and transgender women using HIV PrEP or with known HIV infection. Population-level effects are described as possible but dependent on the implementation approach and scope.

Why does DSTIG recommend against broad implementation of preventive doxycycline?

DSTIG highlights unclear impacts on antimicrobial resistance, including tetracycline resistance in bacterial STI pathogens and effects beyond the STI spectrum, while also noting individual adverse effects and uncertain microbiome and body-weight impacts with frequent intake.

Sep 27, 2026

Uploaded by Stanley