PrEP, DoxyPEP & PEP
Learn about HIV prevention options, including PrEP, DoxyPEP and PEP, and find out which treatments may be right for you.
PrEP
What is PrEP and who should take it?
PrEP or Pre-Exposure Prophylaxis is a pill which when taken as directed can practically eliminate your risk of contracting HIV.
Currently if you feel you’d benefit from taking PrEP, it’s likely you’ll be prescribed via the NHS. But you’d most benefit from PrEP if you are HIV negative and at high risk of HIV. You might be considered at risk of contracting HIV if you:
- Don’t always use condoms for anal or vaginal sex
- Are an injecting drug user who doesn’t always use clean needles
- Are a sex worker
- Have a partner who is HIV positive with a detectable viral load or doesn’t take their HIV medication regularly
- Have had a recent STI (especially a rectal infection or syphilis)
- Use recreational drugs for chemsex (crystal meth, mephedrone and GHB)
- Have recently needed PEP (Post-Exposure Prophylaxis)
If any of these factors apply to you, you will definitely be able to get PrEP for free on the NHS at any GUM clinic across Northern Ireland.
Different PrEP Timings
How do you take PrEP?
How and when to take PrEP
Daily PrEP: for giving/receiving anal & receiving vaginal or front hole sex
Taking PrEP every day is advisable for:
- Anyone who may benefit from having an easier dosing routine
- Anyone who may occasionally accidentally miss a dose
- Those who have Hepatitis B
When starting your first daily dose of PrEP you can take a double dose (two pills) for your first dose BEFORE sex. This gives you protection within two hours.
On-Demand/Event-Based Dosing (2:7)
2:7 on demand dosing (for receiving vaginal/front hole sex) involves:
- Taking a double dose of PrEP (two pills) before you have sex. Ideally this should be done between 2 and 24 hours beforehand.
- Taking a single pill every 24 hours afterward for seven days
Although the pre dose is important for the highest protection, if you miss or are late with the pre dose, taking the double dose as soon as possible will still give some protection.
On-Demand/Event-Based Dosing (2:1)
Start with a double dose (two pills) at least two hours before you are going to have sex. However, instead of continuing to take daily PrEP you only continue for either two (insertive sex or receptive anal sex) or seven days (receptive vaginal/front hole sex) depending on the type of sex you have.
2:1 on demand dosing (for giving vaginal or giving/receiving anal sex) involves:
- Taking a double dose of PrEP (two pills) before you have sex. Ideally this should be done between 2 and 24 hours beforehand.
- Taking a single pill 24 hours after the double dose
- Taking another single pill the following day, 24 hours later
For example, if you’ve had sex once that was either insertive vaginal/anal sex or receptive anal sex:
Or if you’ve had insertive vaginal/anal or receptive anal sex multiple times in a week:
Before PrEP
Things to do before you start PrEP
Get an HIV test
PrEP can only be used if you are HIV negative. If you are HIV positive and take PrEP you may cause drug resistance making your HIV more difficult to effectively treat. You can get a free self-test kit at www.sh24.org.uk or book a rapid HIV and syphilis test at The Rainbow Project. SH24 and GUM use fourth generation tests, meaning that these will tell you if you have HIV as long as you haven’t had any other risks of contracting HIV in the last four weeks. The Rainbow Project use third generation tests, these will tell you if you have HIV as long as you haven’t had any other risks in the past twelve weeks.
It is advised to use condoms for anal or vaginal sex after you’ve completed your HIV tests and before you begin PrEP or to begin PrEP immediately after receiving your HIV negative results. Do not start PrEP if you have flu-like symptoms and had a recent HIV risk. Just in case these symptoms are related to you contracting HIV. If you’ve started PrEP and had a high risk encounter in the last four weeks, you should get another fourth generation test four weeks after beginning PrEP to be certain that an early infection was not missed.
Check your kidneys
Kidney tests involve a blood test for creatine and a urine test for protein. These tests should ideally be done before or on the day you start PrEP. If you are accessing PrEP privately you can still access these tests at a GUM clinic for free. Just call any GUM clinic to book.
Test for Hepatitis B (HBV)
You can still use PrEP if you have HBV but it needs to be used more carefully. You can get tested for Hepatitis B via www.sh24.org.uk who will send you a free self-test kit if they feel you are at risk for HBV.
Your Questions, Answered
PrEP FAQs
Who doesn’t need to take PrEP?
- Your partner is HIV positive and ‘undetectable’ as this means their viral load is so low that they cannot transmit HIV onto anyone else by any means
- If you’re always comfortable and confident to use condoms.
- If you only engage in low risk sexual activities (oral, rimming, hand-jobs)
Are there side effects?
Generally, the vast majority of people taking PrEP do not experience any side effects. Just 1 in 10 people will experience mild nausea, diarrhoea, bloating or headaches but usually these side effects subside in the first month.
Occasionally, PrEP can reduce kidney function and/or bone health. This is why kidney tests are run before and during treatment as a precautionary measure.
What to do if you miss a pill?
If you miss one or two pills occasionally, this will be fine on a daily dosing regime.
If you are daily dosing and miss more than a week of pills you will need to wait until you’ve had at least seven daily doses of PrEP or take a two-pill dose before you are protected from contracting HIV again.
How do I get PrEP on the NHS?
You will need to call your local GUM clinic as you normally would when you’re booking a full STI test but instead ask for a ‘PrEP assessment’
What if I’m not eligible to access PrEP on the NHS?
You can buy genuine, generic-brand PrEP reliably and legally online at www.iwantprepnow.co.uk for as little as £19 per box when you buy three boxes up front.
Please remember you need to have tested negative or non-reactive for HIV recently as taking PrEP when you are living with HIV can cause drug resistance making your HIV more difficult to treat.
You may need to get tested for Hepatitis B and test your kidney function, you can do this at any GUM clinic.
You can download a free PDF “UK Guide to PrEP” from https://i-base.info/guides/prep/pdf for more detailed information on buying and taking PrEP.
If you have any questions or concerns, please do not hesitate to contact our sexual health development officer by call (028 90 319 030) or text (07904864861) and e-mail (leo@rainbow-project.org)
I’m not at high risk of HIV but would still like to take PrEP for peace of mind, is that possible?
Yes, it is! Most GUM clinics will provide PrEP to anyone who enquires about it.
How effective is PrEP?
PrEP is more than 99% effective at stopping HIV infection when taken correctly.
Can I stop PrEP completely?
You can stop taking PrEP whenever you feel it is no longer necessary for you. However, remember to continue taking PrEP daily for seven days if you’ve recently had receptive vaginal sex or continue taking PrEP daily for two days if you’ve recently given or received anal sex.
If in the future your circumstances change again, it is easy to restart PrEP.
How to book a PrEP assessment at your local GUM clinic?
- 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 (John Mitchell Place Newry & Portadown HC): 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)
DoxyPEP
What is DoxyPEP and who should use it?
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.
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.
Medications and DoxyPEP
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.
Medications that can increase your risk of DoxyPEP side effects
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.
Your Questions Answered
DoxyPEP FAQs
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.
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 and 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 sensitive.
Frequent use of DoxyPEP can imbalance ‘good’ bacteria that keeps your gut healthy – you could consider taking a probiotic supplement or eating 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.
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)
- Belfast Trust (Royal Victoria Hospital):
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, with plenty of water and to not lie flat for 30 minutes afterwards.
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.
What is PEP
What is PEP and how to get it?
PEP (post exposure prophylaxis) is a 28 day course of medication that if taken up to 72 hours after unprotected anal or vaginal sex will dramatically reduce your risk of contracting HIV.
PEP must be taken within 72 hours of having unprotected anal or vaginal sex. The sooner you take it after the exposure, the better it works.
PEP is ONLY available from GUM/STI clinics or A&E departments. We’d recommend you visit A&E if GUM is unavailable.
PEP is NOT available at GPs, pharmacies or at The Rainbow Project.
Questions about PEP
PEP FAQs
How to take PEP?
PEP is a 28 day course of medication. It is very important that you:
- Do not skip a dose or fail to complete the full month as this makes it less likely to work.
- Do not double a dose if you miss one.
- If you do miss a dose and you remember in less than 24 hours, take the next one as soon as you remember.
- If you miss more than 48 hours of PEP it will be discontinued.
- Do not take recreational drugs while on PEP as there can be dangerous interactions.
- Tell your doctor about any other prescription/non-prescription/homeopathic remedies you are taking to ensure there are no interactions with PEP.
- Antacids (containing aluminium, magnesium or calcium), multivitamins and iron supplements should be avoided while on raltegravir once daily.
PEP can cause mild side effects such as nausea, tiredness and headaches. Most side effects will lessen as you continue taking your course of medication. Do not stop taking your PEP due to side effects without consulting a healthcare professional first.
Important to Remember
- PEP must be taken within 72 hours, and sooner if possible!
- Attend your nearest GUM/STI clinic or Hospital A&E – don’t wait until the clinic you prefer is open!
- Practice safe sex till you get a negative/non-reactive HIV test.
- Get tested 6-12 weeks after you had unprotected sex.
What happens after I take PEP?
You will have to get tested for HIV to ensure you have not contracted it despite taking PEP. Usually the GUM/STI clinic will book you in for an STI screen three months and six months after your course has completed.
You can book with ourselves a rapid HIV & syphilis test to know your status within ten minutes. You can get tested at least six weeks after the unprotected encounter, as this is when our tests can semi-accurately detect HIV. However, we’d always recommend you return for another test twelve weeks after the encounter, when our tests are their most accurate, to be certain of your status. To find out more about how to get tested visit click here.
Whilst you’re on PEP and awaiting an accurate negative/non-reactive HIV result you should practice safe sex with condoms and lube. You can order a free delivery of condoms & lube via post click here.
If you have unprotected anal or vaginal sex often then you might want to consider taking PrEP. A medication that you can take regularly to maximize your protection from HIV.
