Body Positive’s Mark Fisher explains the ins and outs of this game-changing new syphilis prevention.
Men who have sex with men (MSM) are over 100 times more likely to catch syphilis than our straight counterparts, but did you know there is a cheap treatment already on the market that makes you 80% less likely to contract the disease? So why aren’t Health NZ pushing DoxyPEP as a preventative? Body Positive’s Mark Fisher explains the ins and outs of this game-changing syphilis prevention.
Why is syphilis so prevalent in men who have sex with men in New Zealand?
Syphilis is very prevalent amongst gay and bisexual guys with over 100x the rates seen amongst heterosexuals. It could be called epidemic levels depending on who you ask. The gay community is small and closely connected so the 6 degrees of separation is probably 3 in the gay world and this promotes a greater likelihood of coming into contact with an STI.
The problem with syphilis is that it can be transferred through intimate skin contact and oral sex so even condoms won’t always stop it. The other issue is that syphilis doesn’t always have symptoms but you can still be infectious.
How treatable is syphilis these days?
Syphilis is easy to treat with the antibiotic penicillin. You just need to have a test and then get it sorted at your GP or Sexual Health. If you don’t get it treated it can turn nasty and cause some serious health issues. It’s important to let your sex contacts know so they can be treated as well and you don’t get it again on the next rendezvous. What goes around, comes around.
DoxyPEP seems to have had a massive effect on preventing Syphilis and Chlamydia transmissions overseas. Why is it currently possible to go to your doctor and get Doxycycline for acne but not for STIs?
DoxyPEP is a game changer. It’s taking off overseas as you just need a single dose of doxycycline (usually 2x 100mg tablets at once) to drop your risk of getting syphilis and chlamydia by over 80%. That one dose covers any sex that you have had in the previous 72 hours! Given we have a syphilis epidemic, this is the perfect tool to stop the cycle of reinfection (getting syphilis every time you have a random hookup).
I have not mentioned gonorrhoea as most ghono in NZ is resistant to doxy so it will have little effect. And DoxyPEP is not for HIV prevention so you still need to use condoms or PrEP if that’s your tool of choice.
Doxy is used for lots of different things like acne or as a malaria prevention. This use for STI prevention is new so most GPs won’t know about it and will need some education before they will be comfortable prescribing it. As informed consumers, we can have that conversation, take control of our sexual health, stop getting syphilis, and end the syphilis epidemic!
Historically New Zealand has taken its time adopting tools that would support the sexual health of the rainbow community (Banning Alkyl Nitrates, restricting access to PrEP, promotion of the MPOX Vaccine). Will this be the same with DoxyPEP?
The gay community has been very proactive about sexual health since the appearance of HIV. We like to be the vanguard in terms of taking care of our sexual health. A classic example is when people were importing their own HIV medications whether that was for treatment or for use as PrEP. We knew the tools worked and took the steps needed to make them accessible while the health system caught up.
In the case of doxyPEP there is a hesitation within healthcare around whether the increased use of an antibiotic might encourage an increase in antibiotic-resistant gonorrhoea within the community. Or could there be long-term side effects that we don’t know about yet like gut health issues with increased antibiotic use. The benefits of doxyPEP have to be balanced against the potential risks.  But given doxy is used prolifically for lots of other conditions, you would expect any potential harm would emerge from long-term daily use rather than intermittent dosing and the benefits would far outweigh the risks.
If MSM reading this want to use DoxyPEP to help protect themselves what do you recommend they should do?
The Body Positive website has lots of information about doxyPEP and it includes a link to the Sexual Health Society statement if you need something official to inform your GP. Any healthcare provider can and should prescribe it. If you are on PrEP or living with HIV, just ask at your next regular appointment. Remember that doxyPEP only prevents syphilis and chlamydia – you still need PrEP to prevent HIV.
Internationally, DoxyPEP was endorsed by other countries a while before New Zealand endorsed it.
DoxyPEP has been used for a few years but it has only been recognized officially in the last 12 months. The CDC in the US has just released clinical guidelines on June 4th and Australia made a supporting statement last year. Now that NZ Sexual Health has come out in support of its use, we need to spread the word and ensure that everyone who could benefit is aware and we can halt the spread of syphilis and Chlamydia as fast as possible.
