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SDG 3: STI

Abstract

BACKGROUND

Doxycycline post-exposure prophylaxis (doxy-PEP) has been shown to reduce the incidence of chlamydia and syphilis among men who have sex with men (MSM) at high risk of sexually transmitted infections (STIs). However, doxy-PEP adds antibiotic exposure and may select for tetracycline resistance in both target and bystander bacteria, raising concerns about antimicrobial resistance (AMR). Quantifying additional antibiotic consumption from doxy-PEP is important for assessing its potential AMR impact at population level.

AIM

We estimated the potential increase in doxycycline consumption attributable to doxy-PEP among MSM using HIV pre-exposure prophylaxis (PrEP) in the European Union and European Economic Area (EU/EEA) and compared it with overall doxycycline and tetracycline-class consumption.

METHODS

We used Monte Carlo simulation to estimate annual doxycycline use from doxy-PEP among MSM using PrEP. We estimated population size from the 2024 European MSM Internet Survey and derived doxy-PEP uptake and prescribing frequency from expert elicitation. Estimated consumption in defined daily doses (DDD) per year was compared with tetracycline-class and doxycycline antibiotic use reported by the European Surveillance of Antimicrobial Consumption Network.

RESULTS

Doxy-PEP among MSM using PrEP in the EU/EEA could result in an estimated 4.4 million DDDs of doxycycline annually (95% credible interval (CrI): 0.5–18.1 million), corresponding to a 1.9% increase (95% CrI: 0.2–7.7) relative to 2023 doxycycline consumption.

CONCLUSION

The estimated Doxy-PEP use constitutes a non-negligible share of total doxycycline consumption in the EU/EEA. Monitoring doxy-PEP uptake and AMR indicators will be essential as more countries consider integrating this intervention into STI prevention strategies.

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2026-08-06
2026-09-13
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Estimating the impact of doxycycline post-exposure prophylaxis on antibiotic consumption among men who have sex with men using PrEP in the EU/EEA
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Disa+Hansson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hansson Disa</a>, <a href="/search?value1=Anastasia+Pharris&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pharris Anastasia</a>, <a href="/search?value1=Axel+Jeremias+Schmidt&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schmidt Axel Jeremias</a>, <a href="/search?value1=Kai+J+Jonas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jonas Kai J</a>, <a href="/search?value1=Ulrich+Marcus&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Marcus Ulrich</a>, <a href="/search?value1=Diamantis+Plachouras&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Plachouras Diamantis</a>, <a href="/search?value1=Liselotte+Diaz+H%C3%B6gberg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Högberg Liselotte Diaz</a>, <a href="/search?value1=Otilia+M%C3%A5rdh&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mårdh Otilia</a>, <a href="/search?value1=Jose+Canevari&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Canevari Jose</a></span>. Estimating the impact of doxycycline post-exposure prophylaxis on antibiotic consumption among men who have sex with men using PrEP in the EU/EEA. <a href="/content/ecdc">Euro Surveill.</a> 2026;31(31):pii=2500913. <a href="https://doi.org/10.2807/1560-7917.ES.2026.31.31.2500913" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2026.31.31.2500913</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 03 Dec 2025;&nbsp;&nbsp; <span class="generated">Accepted</span>: 07 May 2026 </span> </p>
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