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Poster Session II: Late-Breakers

(PL1) DOXYCYCLINE POSTEXPOSURE PROPHYLAXIS FOR BACTERIAL SEXUALLY TRANSMITTED INFECTION PREVENTION: THE SAN DIEGO COUNTY DOXY-PEP PILOT PROGRAM

Wednesday, September 18, 2024
4:15 PM - 5:15 PM EST

    Primary Author(s)

  • Myres W. Tilghman, MD (he/him/his)

    Public Health Medical Officer
    County of San Diego Health & Human Services Agency Public Health Services
    Chula Vista, California, United States

    • Co-Author(s)(s)

  • Aaron Briggs, MD (he/him/his)

    Resident Physician
    University of California San Diego-San Diego State University General Preventive Medicine Residency Program

  • RG

    Rosemary Garcia, MD

    Medical Consultant
    County of San Diego Health & Human Services Agency Public Health Services

  • VH

    Victoria Hubbard, MPH

    Epidemiologist II
    County of San Diego Health & Human Services Agency Public Health Services
    San Diego, California, United States

Background:
To address high bacterial sexually transmitted infection (STI) rates among men who have sex with men (MSM) and transgender women (TGW), the San Diego County Sexual Health Clinics (SHCs) initiated a doxycycline postexposure prophylaxis (doxy-PEP) pilot program and assessed client acceptance and tolerance of doxy-PEP.

Methods:
Between August 2, 2023 and May 31, 2024, doxy-PEP was offered according to California Department of Public Health recommendations. Clients were provided a 7-dose doxy-PEP starter pack and a 3-month prescription. Client data was obtained at intake and follow-up clinic visit with laboratory testing at 3 months. STI incidence after doxy-PEP initiation was verified using the state surveillance system.

Results:
As of May 31, 2024, 237 clients were enrolled in the doxy-PEP program. Just 229 (96.6%) were cisgender men, five (2.1%) TGW, and three (1.3%) cisgender women. One-hundred (42.2%) clients were taking HIV pre-exposure prophylaxis (PrEP), 32 (13.5%) were living with HIV, and 105 (44.3%) were neither living with HIV nor taking PrEP. Among 132 clients with follow-up data available, 99 (75%) utilized their starter pack, 58 (44.3%) filled their 3-month prescription, 16 (12.5%) reported side effects, and 11 (8.5%) discontinued doxycycline. Of 35 clients who had follow-up laboratory testing, 13 (37.1%) had minor abnormalities not requiring doxy-PEP discontinuation. Surveillance data was available for 222 patients of whom 37 (16.7%) presented with an incident STI within the study period. Nine (4.1%) patients presented with multiple incident STI contemporaneously,15 (6.8%) were diagnosed with chlamydia, 27 (12.1%) with gonorrhea and four (1.8%) with syphilis. Median time to incident STI was 108 days (IQR 16-174).

Conclusion:
Doxy-PEP was acceptable and well tolerated by SHC clients. Around half of HIV-negative clients, who initiated doxy-PEP, were not on HIV PrEP for unknown reasons. No serious adverse effects or laboratory test abnormalities requiring doxy-PEP discontinuation were observed.