DoxyPEP: A Turning Point for Syphilis Prevention

Today, we're not just marking a shift in clinical practice, we're recognising a moment of progress in the fight against sexually transmitted infections.

The introduction of DoxyPEP (doxycycline post-exposure prophylaxis) into UK sexual health services supported by national guidelines from BASHH represents a genuine leap forward. For many people, this new option offers more than just medical prevention of an infection, it means we can genuinely move from services being focussed on diagnosis and treatment, to prevention.

DoxyPEP is a 200mg dose of doxycycline taken within 72 hours of condomless sex, shown to significantly reduce the risk of bacterial STIs, particularly syphilis.

This development comes in direct response to the year-on-year rise in syphilis diagnoses. Over the centuries, syphilis has been a bane of our lives as doctors and nurses in clinical practice: a disease that has many different clinical presentations, painful or at the very least inconvenient treatment options and if untreated can cause long term damage to the nervous system. History books are full of examples of where untreated syphilis has caused hardship.

After years of promising trial results, including recently the DoxyVac study, we now have clinical guidance that means DoxyPEP can and should be offered as part of routine care for certain groups - particularly gay, bisexual and other men who have sex with men, and trans women already accessing HIV PrEP or with recent STI diagnoses.

STIs have been on the rise in England, and the burden is not shared equally. Gay and bisexual men continue to face disproportionate rates of bacterial STIs, along with stigma, repeat infections, and anxiety about their sexual health.

DoxyPEP isn’t just about reducing numbers, it’s about reducing worry, interrupting cycles of transmission, and ensuring that people feel cared for, heard, and empowered in their choices to have the best sexual health they can.

At LSHP, we will be working with clinicians and commissioners to ensure that the DoxyPEP clinical pathway works for those that need it and is offered in sexual health clinics across the capital with plans to include this in the future through SHL.UK, our e-service.

We will also be monitoring uptake closely and listening to our communities via the Programme’s equality, diversity and inclusion workstreams to understand how this fits into real lives for everyone who would benefit from it.

The introduction of PrEP for HIV was a milestone in our mission to stop new HIV transmissions by giving people something they can take to reduce their risk. DoxyPEP may be a similar milestone for syphilis.

It’s important to remember that DoxyPEP won’t be right for everyone, and it’s not a replacement for condoms or regular screening. But as part of a broader prevention strategy, it opens the door to smarter, kinder, more inclusive care.