WHO Recommends doxyPEP to Help Prevent Rising STI Infections in High-Risk Populations

The introduction of WHO’s first recommendation on doxycycline post-exposure prophylaxis represents a notable advancement in global sexual health policy.

The World Health Organization (WHO) has issued its first-ever recommendation supporting the use of doxycycline post-exposure prophylaxis (PEP), commonly known as doxyPEP, as a preventive measure against certain bacterial sexually transmitted infections (STIs). The landmark guidance is aimed at helping reduce the growing global burden of infections such as syphilis, chlamydia and, in some settings, gonorrhoea among populations at elevated risk.

The recommendation marks a significant development in sexual health prevention strategies and reflects mounting scientific evidence demonstrating that doxycycline, when taken shortly after sexual exposure, can substantially lower the likelihood of acquiring several bacterial STIs.

Health experts view the new guidance as an important addition to existing prevention tools, particularly as STI rates continue to increase in many parts of the world despite ongoing public health efforts.

Growing Global Challenge of Sexually Transmitted Infections

Sexually transmitted infections remain a major public health concern worldwide, affecting millions of people each year and placing significant strain on healthcare systems.

Among the most common bacterial STIs are syphilis, chlamydia and gonorrhoea. If left untreated, these infections can lead to serious health complications, including infertility, chronic pain, adverse pregnancy outcomes and increased vulnerability to HIV infection.

In recent years, many countries have reported rising rates of bacterial STIs, particularly among certain key populations. Public health specialists attribute these trends to a combination of factors, including insufficient prevention options, barriers to healthcare access, stigma and discrimination, and gaps in sexual health education.

The continued increase in infection rates has prompted researchers and health authorities to explore additional prevention strategies beyond traditional approaches.

What Is DoxyPEP?

DoxyPEP refers to the use of doxycycline, a widely available antibiotic, after sexual activity to reduce the risk of developing bacterial sexually transmitted infections.

The approach is similar in concept to post-exposure prophylaxis used for other infectious diseases. Individuals take a prescribed dose of doxycycline within a specified period after potential exposure, with the goal of preventing bacteria from establishing infection.

Multiple scientific studies conducted in recent years have demonstrated promising results, particularly among men who have sex with men and transgender women.

Evidence reviewed by WHO showed that doxyPEP can significantly reduce the risk of syphilis and chlamydia and may also provide some protection against gonorrhoea, although effectiveness can vary depending on local patterns of antibiotic resistance.

New Recommendation Targets High-Risk Populations

WHO's recommendation specifically focuses on men who have sex with men (MSM) and transgender women, populations that continue to experience disproportionately high rates of certain sexually transmitted infections in many regions.

Public health experts emphasize that the recommendation is not intended as a universal prevention strategy for all populations. Instead, it is designed for groups where evidence demonstrates the greatest potential benefit.

Particular priority is given to individuals who have experienced recent or recurrent bacterial STIs, especially syphilis, as they may face a higher likelihood of future infections.

By targeting those at greatest risk, health authorities hope to maximize the public health impact of the intervention while ensuring responsible use of antibiotics.

Expanding the STI Prevention Toolbox

For decades, condoms have remained one of the primary methods for preventing sexually transmitted infections. While highly effective when used correctly and consistently, public health experts recognize that no single prevention strategy is sufficient to address the complex realities of sexual health.

The introduction of doxyPEP adds another evidence-based option that can complement existing prevention measures.

Health professionals view the recommendation as part of a broader shift toward combination prevention approaches that integrate multiple tools tailored to individual needs and circumstances.

Such approaches may include:

• Condom use;

• Regular STI screening and testing;

• HIV prevention services, including PrEP;

• Vaccination where available;

• Sexual health education and counselling;

• Prompt diagnosis and treatment of infections;

• DoxyPEP for eligible individuals.

Combining these interventions can provide stronger protection than relying on any single method alone.

Importance of Comprehensive Sexual Health Services

WHO has emphasized that doxyPEP should not be implemented as a standalone intervention.

Instead, its use should be integrated into comprehensive sexual health programmes that provide a range of preventive, diagnostic and treatment services.

Such programmes should include regular STI testing, access to healthcare professionals, counselling services and appropriate follow-up care.

Health authorities also stress the importance of ensuring that individuals using doxyPEP receive accurate information regarding its benefits, limitations and appropriate use.

Comprehensive care can help maximize effectiveness while supporting broader sexual health outcomes.

Monitoring Antibiotic Resistance Remains Essential

One of the key considerations highlighted by WHO is the need for careful monitoring of antimicrobial resistance.

The growing global challenge of antibiotic resistance has raised concerns about the widespread use of antibiotics for preventive purposes. Overuse or inappropriate use of antibiotics can contribute to the development of resistant bacteria, making infections more difficult to treat in the future.

WHO therefore recommends that countries introducing doxyPEP establish context-specific systems to monitor resistance patterns and assess the long-term impact of implementation.

Public health officials stress that responsible stewardship of antibiotics must remain a priority alongside efforts to expand prevention options.

The organization's guidance seeks to balance the potential benefits of doxyPEP with the need to safeguard the effectiveness of existing antimicrobial treatments.

Addressing Barriers to Prevention

WHO notes that several factors continue to contribute to the rising burden of sexually transmitted infections globally.

Among the most significant challenges are:

• Limited prevention options beyond condoms;

• Inadequate access to comprehensive sexual health services;

• Persistent stigma and discrimination;

• Insufficient integration of STI prevention into HIV and broader health programmes;

• Delayed diagnosis and treatment.

These barriers can discourage individuals from seeking care and contribute to ongoing transmission within communities.

By expanding prevention choices and strengthening service delivery, health authorities hope to improve access to effective sexual health interventions for those who need them most.

Supporting Global Health Commitments

The recommendation aligns with broader international commitments under WHO's Global Health Sector Strategies on HIV, viral hepatitis and sexually transmitted infections.

It also supports goals outlined in United Nations Political Declarations on HIV/AIDS and Universal Health Coverage, which call for expanded access to prevention services and integrated healthcare approaches.

Countries around the world have committed to reducing STI transmission, strengthening healthcare systems and ensuring that vulnerable populations can access high-quality sexual health services without discrimination.

The new guidance provides an additional tool that may help accelerate progress toward these objectives.

WHO to Support Countries in Implementation

To facilitate adoption of the recommendation, WHO plans to provide technical assistance and knowledge-sharing opportunities for national health authorities and stakeholders.

The organization will host webinars and disseminate implementation resources through its Knowledge Sharing Platform, helping countries evaluate how doxyPEP can be integrated into existing health programmes.

National STI programmes and healthcare providers are encouraged to consult WHO guidance before introducing doxyPEP and to ensure implementation reflects local epidemiological conditions and healthcare capacities.

The organization also plans to publish the full guideline, including evidence reviews and decision-making frameworks developed through the internationally recognized GRADE methodology.

These materials will offer detailed information on the scientific evidence supporting the recommendation as well as practical considerations for implementation.

A New Era in STI Prevention

The introduction of WHO's first recommendation on doxycycline post-exposure prophylaxis represents a notable advancement in global sexual health policy.

As bacterial sexually transmitted infections continue to rise in many regions, public health authorities are increasingly seeking innovative and evidence-based approaches to prevention. DoxyPEP offers a promising new option for reducing infection risk among populations most affected by these diseases.

While careful implementation and ongoing monitoring will be essential, health experts believe the recommendation has the potential to improve prevention efforts, strengthen sexual health services and reduce the burden of bacterial STIs worldwide.

The guidance also underscores WHO's commitment to expanding access to effective prevention tools while promoting equitable, comprehensive and person-centred healthcare for all.