Position statement on doxycycline post-exposure prophylaxis for the prevention of bacterial sexually transmissible infections in Aotearoa New Zealand: the New Zealand Sexual Health Society.
Scott J, Giola M, Oliphant J • Sexual health • 2025
The New Zealand Sexual Health Society recommends doxy-PEP be proactively offered to people assigned male sex at birth who have sex with men with a diagnosis of syphilis or two other bacterial STIs in the past 12 months, primarily as an intervention to prevent syphilis.
Key Findings
Background
Recent studies demonstrate that doxycycline post-exposure prophylaxis (doxy-PEP) reduces the risk of syphilis and chlamydia in men who have sex with men (MSM) and transgender women who have sex with men.
The reduction in risk applies specifically to individuals at risk of sexually transmitted infections (STIs).
The evidence base prompted several international organisations to publish guidance regarding doxy-PEP use.
Substantial community and sector interest in New Zealand preceded the development of this position statement.
Methods
The New Zealand Sexual Health Society developed a position statement through a cross-sectoral process involving drafting an interim statement and convening a cross-sectoral meeting to discuss benefits and risks.
The process involved reviewing and revising the interim statement following cross-sectoral discussion.
Discussions covered doxy-PEP benefits and risks including side-effects and antimicrobial resistance.
The statement situates doxy-PEP as part of a comprehensive STI prevention approach rather than a standalone intervention.
Results
There was strong agreement that doxy-PEP should be considered as part of a comprehensive STI prevention approach for people assigned male sex at birth who have sex with men who are at risk of syphilis.
The primary intended use is as an intervention to prevent syphilis.
The recommendation is specifically focused on people assigned male sex at birth who have sex with men.
The statement notes doxy-PEP should be considered within a broader STI prevention framework.
Results
The NZSHS advises that doxy-PEP be proactively offered to people assigned male sex at birth who have sex with men with a diagnosis of syphilis or two other bacterial STIs in the past 12 months.
A diagnosis of syphilis in the past 12 months constitutes one criterion for proactive offering of doxy-PEP.
Two or more other bacterial STI diagnoses in the past 12 months constitutes an alternative criterion.
Doxy-PEP should also be considered for other individuals as outlined in the statement beyond these threshold criteria.
Results
Prescription of doxy-PEP should include counselling on benefits and harms, with users assisted to maximise benefits while minimising overall antibiotic use.
Counselling must specifically address side-effects and antimicrobial resistance concerns.
The statement emphasises minimising overall antibiotic use as a goal alongside maximising doxy-PEP benefits.
STI diagnostic considerations, monitoring, and surveillance are discussed as components of responsible prescribing.
What This Means
This research describes the development and content of an official position statement from the New Zealand Sexual Health Society (NZSHS) on the use of doxycycline as a post-exposure prophylaxis (doxy-PEP) — meaning a single dose of the antibiotic taken within 72 hours after condomless sex — to prevent bacterial sexually transmitted infections (STIs). The statement was developed following evidence from recent studies showing that doxy-PEP reduces the risk of syphilis and chlamydia in gay, bisexual, and other men who have sex with men, as well as transgender women who have sex with men. A cross-sectoral group reviewed this evidence and reached strong agreement on recommendations for New Zealand.
This research suggests that doxy-PEP should be proactively offered to people assigned male at birth who have sex with men if they have been diagnosed with syphilis, or with two or more other bacterial STIs (such as chlamydia or gonorrhoea), within the past year. The primary focus of the recommendation is on preventing syphilis. Healthcare providers are advised to counsel patients on both the benefits and potential harms of doxy-PEP, including antibiotic side effects and the risk of contributing to antimicrobial resistance, and to help users take doxy-PEP in a way that minimises unnecessary antibiotic use overall.
This matters because syphilis rates have been rising in many countries, including New Zealand, particularly among men who have sex with men. Having a formal national position statement helps guide healthcare providers on when and how to offer doxy-PEP, while also flagging important considerations such as antimicrobial resistance surveillance, which is a concern when antibiotics are used more widely. The statement positions doxy-PEP as one tool within a broader approach to sexual health rather than a replacement for other prevention strategies like condom use and regular STI testing.
Scott J, Giola M, Oliphant J. (2025). Position statement on doxycycline post-exposure prophylaxis for the prevention of bacterial sexually transmissible infections in Aotearoa New Zealand: the New Zealand Sexual Health Society.. Sexual health. https://doi.org/10.1071/SH25017