Paulo Roberto Sokoll, Celina Borges Migliavaca, Stephan Döring, Uschi Traub, Karlin Stark, Amanda Veiga Sardeli
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The risk of bias was assessed with the risk-of-bias tool for randomized trials (RoB 2) and the certainty of evidence (CoE) with Grading of Recommendations Assessment, Development and Evaluation (GRADE).</p><p><strong>Results: </strong>Four studies were included in the systematic review, totalling 1727 participants. Studies were conducted between 2015 and 2022. Most participants (73%) were men who have sex with men, and the median age of participants varied from 24 to 43 years. Doxy-PEP reduced the risk of having any bacterial STI in different populations by 46% (hazard ratio (HR) 0.54; 95% CI 0.39 to 0.75; CoE moderate), the risk of chlamydia by 65% (relative risk (RR) 0.35; 95% CI 0.15 to 0.82; CoE low) and syphilis by 77% (RR 0.23; 95% CI 0.13 to 0.41; CoE high), without significant effect for risk of gonorrhoea infection (RR 0.90; 95% CI 0.64 to 1.26; CoE very low). The self-reported adherence rate of Doxy-PEP was approximately 80% and one drug-related serious adverse event was reported.</p><p><strong>Conclusion: </strong>Doxy-PEP reduced the incidence of chlamydia and syphilis infections. No significant reduction in gonorrhoea infection was observed. This strategy seems promising for some high-risk groups; however, there is still a lack of information on the induction of bacterial resistance and long-term adverse events.</p><p><strong>Prospero registration number: </strong>CRD42023454123.</p>","PeriodicalId":21624,"journal":{"name":"Sexually Transmitted Infections","volume":" ","pages":"59-67"},"PeriodicalIF":3.6000,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy of postexposure prophylaxis with doxycycline (Doxy-PEP) in reducing sexually transmitted infections: a systematic review and meta-analysis.\",\"authors\":\"Paulo Roberto Sokoll, Celina Borges Migliavaca, Stephan Döring, Uschi Traub, Karlin Stark, Amanda Veiga Sardeli\",\"doi\":\"10.1136/sextrans-2024-056208\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>This systematic review aimed to identify the efficacy, adherence, safety and impact on antimicrobial resistance of postexposure prophylaxis with doxycycline (Doxy-PEP) in different populations.</p><p><strong>Methods: </strong>We searched MEDLINE (via PubMed), Embase and Cochrane CENTRAL databases from inception to 29 May 2024. Two reviewers independently screened the studies and extracted data. We included randomised clinical trials that evaluated the efficacy of Doxy-PEP within 72 hours after condomless sex. A random-effects meta-analysis was conducted to compare the risk of bacterial sexually transmitted infections (STIs) between Doxy-PEP and no prophylaxis. The risk of bias was assessed with the risk-of-bias tool for randomized trials (RoB 2) and the certainty of evidence (CoE) with Grading of Recommendations Assessment, Development and Evaluation (GRADE).</p><p><strong>Results: </strong>Four studies were included in the systematic review, totalling 1727 participants. Studies were conducted between 2015 and 2022. Most participants (73%) were men who have sex with men, and the median age of participants varied from 24 to 43 years. Doxy-PEP reduced the risk of having any bacterial STI in different populations by 46% (hazard ratio (HR) 0.54; 95% CI 0.39 to 0.75; CoE moderate), the risk of chlamydia by 65% (relative risk (RR) 0.35; 95% CI 0.15 to 0.82; CoE low) and syphilis by 77% (RR 0.23; 95% CI 0.13 to 0.41; CoE high), without significant effect for risk of gonorrhoea infection (RR 0.90; 95% CI 0.64 to 1.26; CoE very low). The self-reported adherence rate of Doxy-PEP was approximately 80% and one drug-related serious adverse event was reported.</p><p><strong>Conclusion: </strong>Doxy-PEP reduced the incidence of chlamydia and syphilis infections. No significant reduction in gonorrhoea infection was observed. 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引用次数: 0
摘要
目的：本系统性综述旨在确定暴露后预防使用强力霉素（Doxy-PEP）在不同人群中的疗效、依从性、安全性以及对抗菌素耐药性的影响：我们检索了从开始到 2024 年 5 月 29 日的 MEDLINE（通过 PubMed）、Embase 和 Cochrane CENTRAL 数据库。两名审稿人独立筛选研究并提取数据。我们纳入了评估无套性行为后 72 小时内强力PEP疗效的随机临床试验。我们进行了随机效应荟萃分析，比较了Doxy-PEP与无预防措施之间的细菌性传播感染（STI）风险。采用随机试验偏倚风险工具（RoB 2）评估偏倚风险，采用建议评估、发展和评价分级（GRADE）评估证据的确定性（CoE）：四项研究被纳入系统综述，共有 1727 人参与。研究在 2015 年至 2022 年间进行。大多数参与者（73%）为男男性行为者，参与者的年龄中位数从 24 岁到 43 岁不等。在不同人群中，Doxy-PEP可将感染任何细菌性 STI 的风险降低 46%（危险比 (HR) 0.54；95% CI 0.39 至 0.75；CoE 中度），将衣原体感染风险降低 65%（相对风险 (RR) 0.35; 95% CI 0.15 to 0.82; CoE low)，梅毒风险降低 77% (RR 0.23; 95% CI 0.13 to 0.41; CoE high)，淋病感染风险无显著影响 (RR 0.90; 95% CI 0.64 to 1.26; CoE very low)。自我报告的Doxy-PEP依从率约为80%，报告了一起与药物相关的严重不良事件：结论：Doxy-PEP 降低了衣原体和梅毒的感染率。结论：Doxy-PEP 可降低衣原体和梅毒感染率，但淋病感染率未见明显降低。对于一些高危人群来说，这一策略似乎很有前景；然而，关于诱导细菌耐药性和长期不良反应的信息仍然缺乏。prospero注册号。
Efficacy of postexposure prophylaxis with doxycycline (Doxy-PEP) in reducing sexually transmitted infections: a systematic review and meta-analysis.
Objectives: This systematic review aimed to identify the efficacy, adherence, safety and impact on antimicrobial resistance of postexposure prophylaxis with doxycycline (Doxy-PEP) in different populations.
Methods: We searched MEDLINE (via PubMed), Embase and Cochrane CENTRAL databases from inception to 29 May 2024. Two reviewers independently screened the studies and extracted data. We included randomised clinical trials that evaluated the efficacy of Doxy-PEP within 72 hours after condomless sex. A random-effects meta-analysis was conducted to compare the risk of bacterial sexually transmitted infections (STIs) between Doxy-PEP and no prophylaxis. The risk of bias was assessed with the risk-of-bias tool for randomized trials (RoB 2) and the certainty of evidence (CoE) with Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results: Four studies were included in the systematic review, totalling 1727 participants. Studies were conducted between 2015 and 2022. Most participants (73%) were men who have sex with men, and the median age of participants varied from 24 to 43 years. Doxy-PEP reduced the risk of having any bacterial STI in different populations by 46% (hazard ratio (HR) 0.54; 95% CI 0.39 to 0.75; CoE moderate), the risk of chlamydia by 65% (relative risk (RR) 0.35; 95% CI 0.15 to 0.82; CoE low) and syphilis by 77% (RR 0.23; 95% CI 0.13 to 0.41; CoE high), without significant effect for risk of gonorrhoea infection (RR 0.90; 95% CI 0.64 to 1.26; CoE very low). The self-reported adherence rate of Doxy-PEP was approximately 80% and one drug-related serious adverse event was reported.
Conclusion: Doxy-PEP reduced the incidence of chlamydia and syphilis infections. No significant reduction in gonorrhoea infection was observed. This strategy seems promising for some high-risk groups; however, there is still a lack of information on the induction of bacterial resistance and long-term adverse events.
期刊介绍：
Sexually Transmitted Infections is the world’s longest running international journal on sexual health. It aims to keep practitioners, trainees and researchers up to date in the prevention, diagnosis and treatment of all STIs and HIV. The journal publishes original research, descriptive epidemiology, evidence-based reviews and comment on the clinical, public health, sociological and laboratory aspects of sexual health from around the world. We also publish educational articles, letters and other material of interest to readers, along with podcasts and other online material. STI provides a high quality editorial service from submission to publication.
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