Real-world implementation of doxycycline postexposure prophylaxis (Doxy-PEP) showed significant reductions in bacterial STIs, particularly rectal Chlamydia trachomatis, but uptake was disproportionately higher among non-Hispanic White individuals and those more engaged in care.
Key Findings
Results
Doxy-PEP use was associated with significant reductions in bacterial STIs, particularly rectal Chlamydia trachomatis infections, among early adopters in propensity-matched analyses.
The study used propensity-matched analyses to compare STI outcomes between Doxy-PEP users and non-users
Reductions were described as 'significant' in the context of a real-world urban sexual health program
The most pronounced effect was observed specifically for rectal Chlamydia trachomatis infections
The study design was a prospective cohort study evaluating real-world effectiveness
Results
Uptake of Doxy-PEP was disproportionately higher among non-Hispanic White individuals compared to other racial and ethnic groups.
Disparities in uptake were identified by race and ethnicity within the diverse urban sexual health program setting in Northern Manhattan
The program serves a diverse population, making the racial disparity in uptake a notable finding
The authors emphasize the need for targeted outreach to improve equitable access to this STI prevention strategy
This disparity mirrors broader patterns of inequitable access to HIV and STI prevention interventions
Results
Doxy-PEP uptake was higher among individuals who were more engaged in care.
Care engagement level was identified as a significant factor associated with Doxy-PEP adoption
Those less engaged in care had lower uptake, suggesting implementation barriers beyond simple availability
The findings underscore the need for targeted outreach to improve care engagement as a prerequisite for equitable Doxy-PEP access
The study was conducted within a sexual health program in Northern Manhattan, which provided the implementation context
Methods
The Doxy-Care study was a prospective cohort study evaluating real-world effectiveness of Doxy-PEP within a diverse urban sexual health program in Northern Manhattan.
The study setting was a diverse urban sexual health program in Northern Manhattan
The study design was prospective cohort with propensity-matched analyses
The study focused on bacterial STI reduction as the primary outcome
Published in American Journal of Public Health in 2025 (115(10):1584-1588)
Conclusions
The authors conclude that targeted outreach is needed to improve care engagement and equitable access to Doxy-PEP as an STI prevention strategy.
Existing disparities in uptake by race/ethnicity and care engagement level motivated this conclusion
The recommendation emphasizes both care engagement improvement and equitable access as distinct but related goals
The findings are positioned within the broader context of STI prevention strategy implementation
The authors frame equitable access as a central concern for public health programs implementing Doxy-PEP
What This Means
This research suggests that doxycycline taken after potential sexual exposure to STIs (called Doxy-PEP) can meaningfully reduce bacterial sexually transmitted infections in real-world settings, not just in controlled clinical trials. The study followed patients at a sexual health clinic in Northern Manhattan and found that people who used Doxy-PEP had significantly fewer STIs — especially rectal chlamydia infections — compared to similar patients who did not use it. The researchers used a statistical technique called propensity matching to make fair comparisons between the two groups.
However, the study also found important gaps in who was actually using Doxy-PEP. Non-Hispanic White patients were more likely to adopt the prevention strategy than patients from other racial and ethnic backgrounds. Additionally, patients who were already more engaged with their healthcare — attending appointments regularly and staying connected to the clinic — were more likely to use Doxy-PEP than those who were less engaged. This means the people who may have the greatest need for STI prevention tools were less likely to be accessing them.
This research matters because it shows both the promise and the limitations of rolling out new STI prevention tools in real communities. While Doxy-PEP appears to work in practice, its benefits are not reaching everyone equally. The authors call for targeted outreach efforts to connect with patients who are less engaged in care and to address racial and ethnic disparities in access, so that the public health benefits of this prevention strategy can be shared more broadly.
Huang S, Carnevale C, Neu N, Klein J, Quigee D, Perez E, et al.. (2025). Implementation of Doxy-PEP in a Diverse Sexual Health Program in Northern Manhattan: The Doxy-Care Study.. American journal of public health. https://doi.org/10.2105/AJPH.2025.308209