What is DoxyPEP?

DoxyPEP  (doxycycline post-exposure prophylaxis) is an antibiotic that if taken up to 72 hours after unprotected sex can reduce your risk of contracting syphilis and chlamydia.

 

Who should use DoxyPEP?

DoxyPEP is available to cisgender gay & bisexual men or MSM (men who have sex with men) and transgender women for free at GUM clinics across Northern Ireland. However if you’re a cisgender woman, a trans man or a person with a vagina and you’ve had a bacterial STI (such as gonorrhoea, syphilis or chlamydia) in the past year or have over five sexual partners within the last three months (including group sex) or participate in chemsex – you may benefit from DoxyPEP so speak to a clinician at the GUM.

 

Who shouldn’t be using DoxyPEP?

If you have a tetracycline allergy (a class of antibiotics that doxyPEP belongs to)

Currently according to BAASH (British Association for Sexual Health and HIV) Guidelines for DoxyPEP there is no clinical evidence to recommend that cisgender women or transgender men or people with vaginas would benefit from DoxyPEP unless they are more at risk of contracting syphilis (i.e engage in sex work, chem sex, group sex or are transgender men or non-binary people who have sex with predominately gay & bisexual men) DoxyPEP will be prescribed to cisgender women, transgender men or people with vaginas on a case-by-case basis.

 

How to take DoxyPEP

DoxyPEP involves taking 200mg of the antibiotic doxycycline within 24 hours and no later than 72 hours after sex. But it’s going to offer you the most protection from syphilis and chlamydia if DoxyPEP is taken within 24 hours after unprotected sex.

If you are having sex on more than one occasion over a 72-hour period, you can take a single 200mg dose of doxycycline at the end of the 72-hour period, rather than multiple doses, to be covered for the entire period.

It’s best to take DoxyPEP after a meal, take with plenty of water and to not lie flat for 30 minutes afterwards. 

 

Other precautions to take when using DoxyPEP

Heavy alcohol use can decrease the effectiveness of doxycycline.

Avoiding taking doxycycline at the same time as antacids containing aluminium, calcium, magnesium or oral zinc, iron salts or bismuth preparations. It’s best to give at least two hours between taking doxyPEP and antacids.

DoxyPEP makes your skin significantly more sensitive to sunlight and UV light. This heightened sensitivity means even brief exposure to the sun can trigger a severe sunburn, so it’s important to avoid using sunbeds and to regularly apply sunscreen with SPF. 

If you’re getting laser hair removal (e.g as gender-affirming care) it is recommended that you wait anywhere between three days and two weeks from your last dose of doxycycline before a session of laser hair removal. This is because DoxyPEP can make your skin more sensitive. If you use DoxyPEP are getting or planning to get laser hair removal ask your hair removal clinic about their doxycycline guidance before you book an appointment. Because it can make your skin more

Frequent use of DoxyPEP can imbalance ‘good’ bacteria that keeps your gut healthy – you could consider taking a probiotic supplement or eat foods like live yogurt, kimchi, kefir, kombucha sauerkraut or miso to help counter this.

If you are taking doxyPEP, it’s recommended that you test for STIs at least once every 3 months.

 

Side Effects of DoxyPEP

Side effects can include: photosensitivity, rash, headache, nausea, vomiting, and upset stomach.

Other side effects such as antimicrobial resistance may be discussed in more detail at your appointment with a clinician. However, from what we know about potential antibiotic resistance  so far there is not a cause for immediate alarm. Long-term use of doxycycline is already prescribed to people who have acne without much concern. Currently the benefits of protecting those at risk from contracting syphilis or chlamydia outweighs most concerns, especially when DoxyPEP is taken as directed.  

 

Other Medications and DoxyPEP 

Medications that do not interfere with DoxyPEP

• HRT (i.e testosterone or oestrogen)
• Oral contraception (i.e the pill) generally – but if you experience vomiting or diarrhoea whilst using DoxyPEP the oral contraception may be less effective.
• PrEP – but if you vomit within one hour of taking your PrEP you should take another dose to ensure its effectiveness.

DoxyPEP has very few negative interactions with other medicines. But these drugs when taken in combination with DoxyPEP can increase your risk of experiencing negative side effects – you should speak to your clinicians if you are taking any of the following below;

• Other antibiotics, such as rifampicin
• Acne medicines containing vitamin A such as isotretinoin
• Warfarin, a medicine that prevents blood clots
• Medicines for epilepsy, like phenytoin or carbamazepine
• Ciclosporin, a medicine for the immune system

Other over-the-counter medicines for indigestion or stomach ulcers (antacids or those than contain bismuth) can reduce the effectiveness of DoxyPEP. Avoid taking these whilst using Doxy PEP or make sure to take these medicines and Doxy PEP at a different time of the day from one another.

 

How to get DoxyPEP

Contact your local GUM clinic for an assessment or if you’re taking PrEP ask about DoxyPEP at your next PrEP review appointment.

• Belfast Trust (Royal Victoria Hospital):
  • Call 028 96 15 2111 (Mon-Friday 8.15am-10.15am)

• Northern Trust (Coleraine, Ballymena & Magherafelt):
  • Call 028 7034 6028

• Western Trust (Altnagelvin & Omagh):
  • Call 028 71 61 1269 (Mon-Fri 8.30am-4.00pm)

• Southern Trust (Jon Mitchell Place, Craigavon & Portadown):
  • Call 028 37 56 2080 (Mon & Weds 9am-4pm and Tues, Thurs & Fri 9am-12pm)

• South-Eastern Trust (Bangor, Downpatrick & Lisburn):
  • Call 028 44 83 8133 (Mon-Fri 9am-4pm)