According to WHO 2024 guidelines, which doxycycline-based post-exposure prophylaxis (doxy-PEP) is now recommended for prevention of bacterial STIs in MSM and transgender women after unprotected sexual exposure?
- A Doxycycline 100 mg daily as pre-exposure prophylaxis
- B Azithromycin 1 g as a single dose monthly
- C Doxycycline 200 mg within 72 hours of exposure, up to 3 times per week ✓
- D Ceftriaxone 500 mg IM with every sexual exposure
Correct answer: C. Doxycycline 200 mg within 72 hours of exposure, up to 3 times per week
Explanation
Doxy-PEP (doxycycline 200 mg taken within 72 hours of unprotected sex, maximum 1 dose per 24-hour window, 3 doses per week) was evaluated in the DoxyPEP trial (NEJM 2023), showing 65–88% reduction in bacterial STI incidence (chlamydia, gonorrhoea, syphilis) in MSM and transgender women on HIV PrEP or living with HIV. WHO 2024 guidelines conditionally recommend doxy-PEP in this population. Concerns include increased gonorrhoea resistance to tetracyclines, which must be monitored. Daily doxycycline is not the approved doxy-PEP regimen.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.