Editor’s Note: The 11th Asia-Pacific AIDS & Co-infections Conference (APACC 2026) was successfully held in Tokyo, Japan. The prevention and control of sexually transmitted infections (STIs) has emerged as one of the most heated topics at the conference. To sort out current cutting-edge prevention and control strategies, Infectious Disease Frontier invited Professor Eric Chow from the Melbourne Sexual Health Centre, Monash University, for an exclusive in-depth interview. In recent years, doxycycline post-exposure prophylaxis (DoxyPEP) has come into public view with solid evidence-based data, opening up new approaches for STI prevention and control. However, its clinical implementation remains surrounded by multiple controversies. Professor Eric Chow conducted a professional discussion on the regimen’s evidence-based value, practical promotion obstacles, adaptability differences across populations, and challenges of localized rollout in Asia, weighing the therapeutic benefits against potential risks including antimicrobial resistance and behavioral changes.
Combining findings from multiple overseas clinical trials and the current status of regional practice, he objectively analyzed the pros and cons of this cutting-edge prevention and control strategy as well as its implementation pathways, providing a reference perspective for relevant medical practitioners in China.
Infectious Disease Frontier: Could you share the key evidence-based medical findings on the use of DoxyPEP for STI prevention, and what are the landmark implications of these findings?
Prof. Eric Chow: Doxycycline post-exposure prophylaxis, or DoxyPEP for short, is an intervention regimen involving oral administration of 200 mg doxycycline within 72 hours after sexual exposure. Multiple clinical trials have confirmed the efficacy of DoxyPEP, with results showing that this regimen can significantly reduce the incidence of syphilis and chlamydia, although its effectiveness against gonorrhea is more modest.
Infectious Disease Frontier: What are the key challenges facing the real-world implementation of DoxyPEP — such as the risk of antimicrobial resistance, long-term adherence, cost-effectiveness, and differences in acceptance across different sexual orientation groups? How should we weigh the benefits against the risks?
Prof. Eric Chow: The DoxyPEP regimen faces many concerns and challenges during its initial rollout phase. First is the potential risk of antimicrobial resistance. There are concerns that DoxyPEP may contribute to increased antimicrobial resistance or selection of tetracycline-resistant strains in Neisseria gonorrhoeae and other bacterial species although the long-term population-level impact remains unclear. Second are concerns about behavioral risks. Both community members and healthcare providers worry that the implementation of DoxyPEP may alter people’s preventive behaviors against sexually transmitted infections — for instance, whether it will lead to reduced condom use and a higher proportion of condomless sex.
In addition, research we conducted in Australia has identified numerous misconceptions in the community: some people mistakenly believe that DoxyPEP can prevent HIV infection and mpox, which is not supported by current evidence. Therefore, when implementing doxyPEP, it is essential to provide adequate community education, improve awareness of its intended use, and develop appropriate educational resources to support its safe and effective use.
Infectious Disease Frontier: What are the key populations from which the current evidence on DoxyPEP for STI prevention is derived? In your view, what are the major challenges in scaling up this approach across different countries and populations in Asia?
Prof. Eric Chow: Research evidence for DoxyPEP has primarily been generated among men who have sex with men and transgender populations. However, the dPEP study conducted in Kenya was the first doxyPEP trial among cisgender women and found that doxyPEP did not reduce STIs incidence. Subsequent analyses suggested that low adherence may have contributed to the loack of observed effectiveness. Further research is needed to evaluate the effectiveness of doxyPEP among cisgender women and female sex workers.
In terms of on-the-ground implementation, several challenges remain. One of the key concerns is the potential impact of doxyPEP on antimicrobial resistance in STI and other commensals and pathogens. Ongoing surveillance will be important to monitor thses potential impacts. Another challenges is drug accessibility as some countries have not yet issued corresponding national guidelines, limiting the policy framework of doxyPEP implementation. Notably, the World Health Organization (WHO) recently released the doxyPEP guidelines, which may drive encourage more countries to consider localized implementation pathways, particularly through integration into their national HIV/STI prevention strategies and related healthcare services.
