Awareness, attitudes and early use of doxycycline prophylaxis among gbMSM in Ireland: findings from a 2025 community-based cross-sectional survey.

Abstract

Background: Bacterial sexually transmitted infections (STIs) remain a growing public health challenge globally, with gay, bisexual and other men who have sex with men (gbMSM) disproportionately affected. Doxycycline postexposure prophylaxis (DoxyPEP) has been shown in clinical trials to reduce syphilis and chlamydia, and has been incorporated into US and UK guidelines. However, community-level data in many European countries remain scarce. This study aimed to assess awareness, attitudes and early use of DoxyPEP among gbMSM in Ireland.

Methods: An anonymous, cross-sectional online survey was conducted between May and June 2025. Eligible participants were aged ≥18 years, identified as male (cis or trans) or non-binary/gender diverse and reported sex with a man in the past 12 months. The questionnaire covered demographics, sexual behaviours, STI/HIV history, awareness and use of antibiotics for STI prevention and attitudinal measures. Descriptive statistics summarised findings, and logistic regression identified predictors of DoxyPEP use.

Results: A total of 149 participants completed the survey, with a mean age of 36.4 years (range: 22-67); 92.6% were cisgender men and 86.6% identified as gay. Awareness of antibiotic STI prophylaxis was high (83.2%), and 69.1% expressed strong interest in future use. Over one-quarter (29.5%) reported DoxyPEP use in the past 12 months, almost exclusively at the recommended 200 mg dose. DoxyPEP use was associated with previous HIV PEP use (adjusted OR (AOR) 3.02 s, 95% CI 1.35 to 6.73) and group sex (AOR 3.27, 95% CI 1.26 to 8.59). Most participants reported sourcing antibiotics informally, including online or through friends. Antimicrobial resistance was the most common concern reported (69.8%).

Conclusion: Despite the absence of national guidelines on the use of DoxyPEP for STI prevention, over one-quarter of participants reported using DoxyPEP, with high awareness and demand for structured access. These findings highlight the urgency for evidence-based, internationally aligned policies that ensure safe and equitable delivery, integrated within sexual health services and underpinned by antimicrobial stewardship.