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Global Data Show Limited DoxyPEP Protection Against Gonorrhea

Content Editor: Dr. Sampriti

July 19, 2025 at 4:47:46 PM

International Health News, STI, anti-microbial resistance(AMR)

Content Editor: Dr. Sampriti

  • Global data indicate doxycycline post-exposure prophylaxis (doxyPEP) may offer limited protection against gonorrhea  due to high tetracycline resistance in Neisseria gonorrhoeae. 

  • A meta-analysis of 80,645 Neisseria gonorrhoeae samples drawn from 67 studies conducted between 1996 and 2013 across 51 countries revealed the following:

  1. a median tetracycline resistance rate of 54.2%, with values ranging from 4% to 100%.

  2. The highest resistance levels were observed in the East Asia/Pacific region (82.1%) and sub-Saharan Africa (81.6%)

  3. North America reported the lowest rate at 26.5%.

  4. Analysis from Seattle showed tetracycline resistance genes (tetM) in U.S.

  5. N. gonorrhoeae rising from ~10% in 2020 to over 30% by mid‑2024.

  • This surge, linked to doxycycline use for chlamydia and the doxyPEP rollout, raises concern that doxyPEP’s ~55% efficacy against gonorrhea in trials may be undermined. 

  • The authors recommend clear messaging that doxyPEP is unreliable for gonorrhea prevention and call for strengthened resistance surveillance in countries using doxyPEP.

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