New era in STI prevention: early adoption of doxyPEP and 4CMenB vaccination among a community sample of men and gender-diverse people having sex with men in England-findings from a large, cross-sectional survey in 2025.

Abstract

Objectives: In 2025, England commenced doxycycline postexposure prophylaxis (doxyPEP) for people at elevated syphilis risk and a 4CMenB vaccination programme for gonorrhoea prevention. We examine early adoption of these new preventative interventions within a community sample.

Methods: We analysed data from 'Reducing inequalities in Sexual Health', an online community survey of men and gender-diverse people who have sex with men, conducted in November-December 2025. We describe doxyPEP use (past 3-4 months) and 4CMenB vaccination (≥1 dose ever) among England-resident participants, including those reporting suggested eligibility criteria under national guidance (≥5 male condomless anal sex partners and/or a recent bacterial sexually transmitted infection diagnosis, herein 'intervention-eligible'). Among intervention-eligible participants, associations between doxyPEP use and 4CMenB vaccination with sociodemographic characteristics, clinical and behavioural history and well-being measures were assessed using Pearson's χ² tests.

Results: Among 1518 England-resident participants (87% white; median age 49 years (IQR 38-59)), 18% reported doxyPEP use (95% CI 16% to 20%; 279/1518) and 21% reported 4CMenB vaccination (95% CI 19% to 23%; 318/1518). Of 421 intervention-eligible participants (28%), 39% reported doxyPEP use (95% CI 35% to 44%; 165/421) and 41% reported 4CMenB vaccination (95% CI 36% to 46%; 173/421). DoxyPEP use and 4CMenB vaccination among those offered these interventions were high (exceeding 88% in those intervention-eligible). Among intervention-eligible participants, doxyPEP use was significantly higher (p<0.05) among London residents (50% vs 35% outside London), those with degree-level education (46% vs 30%) and those employed (43% vs 31%). 4CMenB vaccination was largely consistent across subgroups except by age (45% in ≥45 year-olds vs 24% in 16-29 year-olds). Those reporting recent HIV pre-exposure prophylaxis use were more likely to report adoption of both interventions.

Conclusions: Findings indicate substantial early adoption of doxyPEP and 4CMenB vaccination in England, with early 4CMenB vaccination appearing more uniform relative to doxyPEP. Ongoing monitoring is essential to identify emerging inequities and to understand factors driving them as rollout progresses.