背景:多西环素暴露后预防(doxy-PEP)涉及在无套性行为后72小时内服用200mg多西环素,以降低细菌性性传播感染(STIs)的风险。最近doxy-PEP的临床试验表明梅毒显著减少,衣原体和,在较小程度上,同性恋中的淋病,双性恋和其他与男性发生性关系的男性(GBMSM)。GBMSM社区对doxy-PEP有很高的兴趣,作为回应,澳大利亚艾滋病学会,病毒性肝炎和性健康医学(ASHM)举行了全国共识会议,旨在为临床医生提供初步指导,社区,研究人员和政策制定者。
结论:达成了广泛的共识,应将doxy-PEP主要用于预防有性传播感染风险的GBMSM中的梅毒,第二个好处是减少其他细菌性传播感染。在共识进程结束时,仍然存在一些分歧,因为一些利益相关者强烈认为doxy-PEP应该只考虑用于预防GBMSM中的梅毒,并且抗菌素耐药性增加的风险超过目标人群中其他细菌性传播感染减少的任何潜在益处。全国圆桌会议为临床医生提出了其他一些建议,社区,研究人员和政策制定者,正如本文所详述的。ASHM将支持制定有关doxy-PEP的详细临床指南和教育材料(www。ashm.org.au/doxy-pep)。
■对于梅毒高风险的GBMSM,也许还有其他细菌性传播感染,临床医生可能会考虑在有限的时间内开Doxy-PEP,然后是对持续需求的审查。与人类免疫缺陷病毒(HIV)暴露前预防(PrEP)不同,doxy-PEP可能不适合作为人群水平的干预措施,应该更有选择性地使用.
BACKGROUND: Doxycycline post-exposure prophylaxis (doxy-PEP) involves consuming 200 mg of doxycycline up to 72 hours after a condomless sex act to reduce the risk of bacterial sexually transmitted infections (STIs). Recent clinical trials of doxy-PEP have demonstrated significant reductions in syphilis, chlamydia and, to a lesser degree, gonorrhoea among gay, bisexual and other men who have sex with men (GBMSM). There is a high level of interest in doxy-PEP in the GBMSM community and, in response, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) held a national
consensus conference with the aim of creating preliminary guidance for clinicians, community, researchers and policy makers.
CONCLUSIONS: There was broad agreement that doxy-PEP should be considered primarily for the prevention of syphilis in GBMSM who are at risk of this STI, with a secondary benefit of reductions in other bacterial STIs. At the end of the
consensus process, there remained some disagreement, as some stakeholders felt strongly that doxy-PEP should be considered only for the prevention of syphilis in GBMSM, and that the risk of increasing antimicrobial resistance outweighed any potential benefit from reductions in other bacterial STIs in the target population. The national roundtable made several other recommendations for clinicians, community, researchers and policy makers, as detailed in this article. ASHM will support the development of detailed clinical
guidelines and education materials on doxy-PEP (www.ashm.org.au/doxy-pep).
UNASSIGNED: For GBMSM at high risk of syphilis, and perhaps other bacterial STIs, clinicians may consider prescribing doxy-PEP for a limited period of time, followed by a review of ongoing need. Unlike human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP), doxy-PEP may not be suitable as a population-level intervention and should instead be used more selectively.