Doxycycline Postexposure Prophylaxis and Sexually Transmitted Infection Trends.

IF 22.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Madeline Sankaran, David V Glidden, Robert P Kohn, Trang Q Nguyen, Oliver Bacon, Susan P Buchbinder, Monica Gandhi, Diane V Havlir, Courtney Liebi, Anne F Luetkemeyer, Janet Q Nguyen, Jorge Roman, Hyman Scott, Thiago S Torres, Stephanie E Cohen
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引用次数: 0

Abstract

Importance: Increasing rates of sexually transmitted infections (STIs) have been associated with rises in serious morbidity. While doxycycline postexposure prophylaxis (doxyPEP), a strategy in which individuals take doxycycline, 200 mg, after condomless sex to prevent bacterial STIs, has been shown to be efficacious in randomized clinical trials, doxyPEP's potential effect on population-level STI incidence is unknown.

Objective: To assess the association of citywide doxyPEP guideline release with reported chlamydia, gonorrhea, and early syphilis cases in men who have sex with men (MSM) and in transgender women in San Francisco, California.

Design, setting, and participants: This population-level interrupted time series analysis of reported San Francisco STI cases measured monthly cases of chlamydia, gonorrhea, and early syphilis prior to (July 2021-October 2022) and after (November 2022-November 2023) release of citywide doxyPEP guidelines in October 2022. All reported chlamydia, gonorrhea, and early syphilis cases among MSM and transgender women in San Francisco during the period of analysis were included. Data were analyzed November 2023 to July 2024.

Exposure: Release of doxyPEP citywide guidelines.

Main outcomes and measures: The primary outcome was the percentage change between projected and observed chlamydia, gonorrhea, and early syphilis cases in the 13-month postexposure period.

Results: Citywide, there were 6694 cases of chlamydia, 9603 cases of gonorrhea, and 2121 cases of early syphilis among MSM and transgender women during the analytic period. STI cases among MSM and transgender women decreased significantly compared with model projections for chlamydia (-6.58% per month; 95% CI, -7.99% to -5.16%) and early syphilis (-2.68% per month; 95% CI, -3.75% to -1.60%) after doxyPEP implementation. By the end of the 13-month postperiod in November 2023, chlamydia and early syphilis cases decreased -49.64% (95% CI, -59.05% to -38.06%) and -51.39% (95% CI, -58.21% to -43.46%), respectively, compared with projected cases. There was a significant increase in monthly gonorrhea cases compared with projections (1.77% per month; 95% CI, 0.87% to 2.67%).

Conclusions and relevance: This study suggests that San Francisco's doxyPEP guideline release was associated with decreases in reported cases of chlamydia and early syphilis, but not gonorrhea, among MSM and transgender women in San Francisco. Further analyses are needed to assess whether declines are sustained and monitor for adverse consequences, including antimicrobial resistance. Supporting doxyPEP implementation for MSM and transgender women at risk for STIs could have a significant impact on the nationwide STI epidemic.

多西环素暴露后预防和性传播感染趋势。
重要性:性传播感染(STIs)发病率的上升与严重发病率的上升有关。虽然在随机临床试验中已证明,在无安全套性行为后个体服用强力霉素200毫克以预防细菌性性传播感染的多西环素暴露后预防(doxyPEP)策略有效,但doxyPEP对人群性传播感染发病率的潜在影响尚不清楚。目的:评估旧金山市全市doxyPEP指南发布与报告的男男性行为者(MSM)和变性女性衣原体、淋病和早期梅毒病例的关系。设计、环境和参与者:在2022年10月全市doxyPEP指南发布之前(2021年7月至2022年10月)和之后(2022年11月至2023年11月),对报告的旧金山性传播感染病例进行人口水平中断时间序列分析,测量衣原体、淋病和早期梅毒的每月病例。在分析期间,所有报告的旧金山男男性行为者和跨性别妇女的衣原体、淋病和早期梅毒病例被包括在内。数据分析时间为2023年11月至2024年7月。曝光:发布全市doxyPEP指南。主要结局和测量:主要结局是暴露后13个月预计和观察到的衣原体、淋病和早期梅毒病例的百分比变化。结果:分析期内,全市MSM和跨性别女性衣原体感染6694例,淋病9603例,早期梅毒2121例。与衣原体模型预测相比,MSM和变性女性中的性传播感染病例显著下降(每月-6.58%;95% CI, -7.99%至-5.16%)和早期梅毒(每月-2.68%;95% CI, -3.75%至-1.60%)。到2023年11月13个月后结束时,衣原体和早期梅毒病例与预计病例相比分别下降了-49.64% (95% CI, -59.05%至-38.06%)和-51.39% (95% CI, -58.21%至-43.46%)。与预测相比,每月淋病病例显著增加(每月1.77%;95% CI, 0.87%至2.67%)。结论和相关性:本研究表明,旧金山doxyPEP指南的发布与旧金山MSM和跨性别女性中衣原体和早期梅毒报告病例的减少有关,但与淋病报告病例无关。需要进一步分析以评估下降是否持续,并监测包括抗菌素耐药性在内的不良后果。支持针对有感染性传播感染风险的男男性行为者和跨性别妇女实施doxyPEP,可能会对全国性传播感染流行产生重大影响。
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来源期刊
JAMA Internal Medicine
JAMA Internal Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
43.50
自引率
1.30%
发文量
371
期刊介绍: JAMA Internal Medicine is an international, peer-reviewed journal committed to advancing the field of internal medicine worldwide. With a focus on four core priorities—clinical relevance, clinical practice change, credibility, and effective communication—the journal aims to provide indispensable and trustworthy peer-reviewed evidence. Catering to academics, clinicians, educators, researchers, and trainees across the entire spectrum of internal medicine, including general internal medicine and subspecialties, JAMA Internal Medicine publishes innovative and clinically relevant research. The journal strives to deliver stimulating articles that educate and inform readers with the latest research findings, driving positive change in healthcare systems and patient care delivery. As a member of the JAMA Network, a consortium of peer-reviewed medical publications, JAMA Internal Medicine plays a pivotal role in shaping the discourse and advancing patient care in internal medicine.
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