In a significant move aimed at expanding the global toolkit for preventing sexually transmitted infections (STIs), the World Health Organization (WHO) has issued its first recommendation supporting the use of doxycycline as post-exposure prophylaxis (PEP) for certain high-risk populations. The WHO, however, has clarified that the intervention, commonly referred to as doxyPEP, should not be viewed as a standalone solution.
The guidance recommends the use of doxycycline after sexual exposure among men who have sex with men and transgender women, groups that continue to face a disproportionate burden of bacterial STIs in many parts of the world.
The recommendation follows a review of growing scientific evidence showing that a single course of the antibiotic, taken soon after sexual contact, can substantially reduce the risk of acquiring infections such as syphilis and chlamydia and may also offer some protection against gonorrhoea in specific settings.
DoxyPEP involves taking doxycycline after potential exposure to an STI rather than before exposure. Public health experts view it as a potentially valuable addition to existing preventive measures, particularly at a time when STI rates are rising across several regions despite ongoing awareness campaigns and access to treatment.
According to the WHO, bacterial sexually transmitted infections remain a major public health concern worldwide. Syphilis, chlamydia and gonorrhoea continue to cause significant illness and can lead to severe complications if left untreated. These include infertility, chronic pain, adverse pregnancy outcomes and an increased risk of HIV transmission.
Announcing the recommendation, Dr. Tereza Kasaeva, Director of WHO’s Department for HIV, TB, Hepatitis and STIs, said the guidance represents an important advance in expanding evidence-based prevention options for populations at elevated risk.
She noted that countries and health partners should work together to ensure that those most vulnerable to infection can benefit from scientifically validated preventive strategies.
The WHO said doxyPEP should be integrated into a broader sexual health framework that includes regular testing, counselling, access to treatment, condom use and other preventive services. The organisation also advised that priority be given to individuals with a recent history of STIs or recurrent infections, particularly syphilis.
A key aspect of the recommendation is the need for careful monitoring of antimicrobial resistance. Health experts have long warned that the widespread and inappropriate use of antibiotics can accelerate the emergence of drug-resistant bacteria, potentially undermining the effectiveness of existing treatments. WHO has therefore called for country-specific surveillance mechanisms to track resistance patterns as doxyPEP programmes are introduced and expanded.
The new guidance aligns with broader international commitments under WHO’s Global Health Sector Strategies on HIV, viral hepatitis and STIs, as well as commitments made through United Nations declarations on HIV/AIDS and Universal Health Coverage. These frameworks encourage countries to strengthen integrated prevention efforts and improve access to comprehensive sexual and reproductive health services.
Despite progress in diagnosis and treatment, STI rates continue to climb in many countries. Public health specialists attribute this trend to several factors, including limited preventive options beyond condoms, inadequate access to comprehensive sexual health services, social stigma and discrimination, and insufficient integration of STI prevention into HIV and primary healthcare programmes.
Stigma and fear of discrimination often discourage individuals from seeking timely testing and treatment, allowing infections to spread undetected within communities, according to various reports. Expanding prevention choices, they argue, could help address some of these gaps while improving engagement with healthcare services.
To support implementation of the recommendation, WHO plans to organise a series of webinars and technical discussions for national health authorities and programme managers. The agency will also disseminate updates through its knowledge-sharing platforms and provide technical support to countries considering adoption of the intervention.
National STI programmes and other stakeholders have been encouraged to consult WHO guidance before introducing doxyPEP into routine practice. The world health body said a detailed guideline, including evidence reviews and decision-making frameworks developed using internationally accepted assessment methods, will be released in the coming months and incorporated into WHO’s consolidated STI guidelines.
