Syphilis Rates Among Gay, Bi Men Fall Significantly, Confirm Doxy-PEP Effectiveness

Gay and bi men are taking health seriously, adopting the use of doxycycline as a "morning after" preventative against syphilis and other STIs. The result, NBC News reported, is a 10% decrease in syphilis rates across the board, with an even starker drop in infection rates – 13% – among gay and bisexual men.

The news comes from the Centers for Disease Control and Prevention, which published a report on Nov. 12 detailing STI rates in 2023.

NBC News noted that gay and bisexual men "are about 2% of the adult population but have historically accounted for nearly half" of syphilis diagnoses. "STIs also spread disproportionately among young people and racial minorities," NBC News noted.

Syphilis was not the only STI to decrease last year. "Overall, gonorrhea declined by 7%, to 601,300 cases," NBC News said, adding that the fall in cases "followed a 9% decline the previous year."

Meanwhile, "Chlamydia remained stable from 2021 to 2023, at about 1.65 million cases."

The head of the CDC's STI prevention division, Dr. Laura Bachmann, hailed the results but urged that efforts to lower STI rates continue.

"I think we're at an inflection point," Dr. Bachmann said, "and it's important that we push forward and take advantage of innovations and investment of STI prevention going forward."

Citing "a half-dozen other infectious disease experts," NBC News described a belief among experts that the promising new trend "was likely to be an early signal of [gay and bisexual] men's eager adoption of a new, proven protocol in which the oral antibiotic doxycycline is used for STI prevention."

The report confirms what recent data has been saying about the effectiveness of using doxycycline as a post-exposure prophylaxis – "Doxy-PEP," as health professionals call it.

"In recent years, a trio of randomized controlled trials have shown that instructing gay and bisexual men and transgender women to take one 200-milligram tablet of doxycycline within 72 hours of condomless sex lowers cases of chlamydia and syphilis among them by more than 70% and of gonorrhea by about 50%," NBC News detailed.

San Francisco was an early adopter, becoming "the first city to recommend doxyPEP for gay and bisexual men and transgender people" two years ago.

The results were dramatic.

As previously reported, information presented at the Conference on Retroviruses and Opportunistic Infections earlier this year showed that "Over the next year, chlamydia cases dropped steeply and syphilis also fell," though "the decline in gonorrhea was minimal."

New York City's Department of Health followed up, issuing guidelines last fall that explained the results of relevant studies and encouraged health care providers to administer doxycycline where appropriate.

The study results also confirm a growing trend of LGBTQ+ people leading the way in terms of embracing fact-driven medical science in order to safeguard health.

Despite health care disparities, queer Americans got vaccinated against COVID-19 at higher rates during the pandemic. More recently, gay and bisexual men took action to derail what could have become an Mpox pandemic, even though the outbreak worsened health care disparities for some.

That sort of community awareness and action may prove crucial in future health crises.

"Public health experts have attributed this century's surge in STIs, at least in part, to a steady defunding of state and local public-health clinics," NBC News noted.

Still, concerns remain. NBC News noted that health experts fear resistant strains of STI might emerge as Doxy-PEP use continues.

Moreover, there's a social component to consider. NBC News relayed that "STI-prevention experts are also concerned that, as with HIV PrEP, doxyPEP will prove disproportionately popular among whites and thus will only widen racial disparities in STI transmission."

"Research is underway to analyze trends in doxyPEP's use that could help focus promotion of the intervention where the need is greatest."