"It's Been a Very Liberating Experience": Doxycycline Postexposure Prophylaxis for Sexually Transmitted Infection Prevention and Experiences With Sexual Pleasure by Men Who Have Sex With Men.
Men who have sex with men reported that doxy-PEP use improved their sexual pleasure and intimacy with partners, with positive experiences similar in men living with and without HIV.
Key Findings
Results
Doxy-PEP use improved quality of life by providing peace of mind and resulted in more enjoyable sex experiences and increased intimacy among MSM.
43 DoxyPEP trial participants were interviewed from November 2021 to December 2022
Participants were enrolled in a clinical trial of doxy-PEP (NCT03980223)
Median age was 38 years (interquartile range, 34-46 years)
Qualitative thematic analysis was applied to interview transcripts and debrief reports
Participants were purposively sampled to capture a range of doxy-PEP use frequency
Results
Doxy-PEP provided participants with a sense of freedom to choose about condom use and selection of sexual partners.
Participants described doxy-PEP as liberating in their sexual decision making
The study used the Sexual Health Model as a framework to assess intimacy and sexual pleasure
Freedom related to condom use choices was a distinct theme emerging from participant interviews
Partner selection choices were also reported as influenced by doxy-PEP use
Results
Doxy-PEP supported communication with sexual partners about STI prevention.
Improved partner communication was identified as a thematic finding across interviews
This finding was consistent among both men living with and without HIV
19 (44%) of the 43 participants were living with HIV
Interviews explicitly explored how doxy-PEP influenced relationships and intimacy
Results
Positive sexual experiences associated with doxy-PEP were similar in men living with and without HIV.
19 of 43 participants (44%) were living with HIV
Themes of improved pleasure, intimacy, and peace of mind were consistent across HIV status
The sample was 63% White, 18% Black, and 38% Hispanic
Purposive sampling was used to ensure diversity in doxy-PEP use frequency
Conclusions
Recognizing the positive aspects of doxy-PEP, including improved sexual pleasure, is considered essential for tailoring messaging and counseling to motivate doxy-PEP use.
Authors frame pleasure as a key component in sexual decision making
The Sexual Health Model was used as the theoretical framework for the study
Findings suggest that pleasure-affirming counseling approaches may support doxy-PEP uptake
The authors conclude that positive experiences 'could motivate doxy-PEP use'
What This Means
This research suggests that doxycycline postexposure prophylaxis (doxy-PEP) — an antibiotic taken after potential STI exposure to reduce the risk of bacterial infections like chlamydia, gonorrhea, and syphilis — does more than just prevent infections. In interviews with 43 gay and bisexual men enrolled in a clinical trial, participants described how taking doxy-PEP gave them a sense of peace of mind that made their sexual experiences more enjoyable and helped them feel more intimate with their partners. Many described feeling liberated in their sexual choices, including decisions about condom use and partner selection.
The study also found that doxy-PEP appeared to make it easier for men to talk openly with their sexual partners about STI prevention. Importantly, these positive experiences were reported similarly by men living with HIV and those without HIV, suggesting that the benefits extend across different groups. The research used a framework called the Sexual Health Model, which treats pleasure and intimacy as legitimate and important parts of sexual health, not just disease prevention.
This research suggests that healthcare providers and public health programs promoting doxy-PEP should consider highlighting these pleasure-related and quality-of-life benefits in their messaging and counseling. Focusing only on disease prevention may miss an important motivating factor for people considering whether to use doxy-PEP. Acknowledging that STI prevention tools can enhance rather than detract from sexual experiences may help more people engage with and adhere to prevention strategies.
Perkins R, Fredericksen R, Christopoulos K, Beima-Sofie K, Cohen S, Dombrowski J, et al.. (2025). "It's Been a Very Liberating Experience": Doxycycline Postexposure Prophylaxis for Sexually Transmitted Infection Prevention and Experiences With Sexual Pleasure by Men Who Have Sex With Men.. Sexually transmitted diseases. https://doi.org/10.1097/OLQ.0000000000002220