John Saunders

Clinical academic. HIV prevention, sexual & public health. He/Him/His. Views my own. RTs for interest not endorsement.

[Fabian YS Kong (He/Him) @fabysk.bsky.social @fabian_kong]

@manik_psk @SF_DPH @BASHH_UK @DrWillN @TeamPrepster @UKHSA @drlaurajwaters @CDCSTD I am so worried about doxy p(r)ep. These guidelines are lacking in AMR info even tho the trial showed doubling of NG resistance. Likely doxy will effect commensals (https://t.co/qXHRz2Wq6W) ➡️more deaths due to AMR (https://t.co/QhQ5w3MEUM). @JHocking01 @MicroDx_UQ

[UCL Clinical Research in Infection & Sexual Health @UCL_CRISH]

Our very own @manik_psk was invited to present on doxycycline as prophylaxis for STIs at the @IUSTI_Europe conference @BASHH_UK seminar today. He highlighted the BASHH position statement & recent statement/guideline update from @CDCgov @CDCSTD

[ISSTDR @isstdr]

Abstracts due 15 January! STI&HIV 2023 World Congress in Chicago 24-27 July 2023. @ProfKevinFenton, Dr. Leandro Mena, Dr. Teo Wi on the stage. Cutting-edge talks on trust in science, health inequalities, sexual rights, AMR, community engagement, and MORE! #STIHIV2023

[Fabian YS Kong (He/Him) @fabysk.bsky.social @fabian_kong]

@JncherabieMD @saunders_j But the recent DoxyPrep found a doubling of Tc resistance in the doxy arm but not In control arm - so AMR is occurring. I’m more concerned about commensal AMR Eg S.aureus that can kill then for GC per se.

[Joseph Cherabie MD, MSc 🏳️‍🌈 (He/They) @JncherabieMD]

DoxyPEP should most definitely be integrated in HIV PrEP and HIV ART services!!

[Joseph Cherabie MD, MSc 🏳️‍🌈 (He/They) @JncherabieMD]

Other implementation considerations:
Doxycycline is affordable out of pocket!
Lab monitoring is more difficult (as always) - consider CBC, renal, and liver function test monitoring periodically (every 6 months? annually?)
STI screening every 3-6 months?

[Joseph Cherabie MD, MSc 🏳️‍🌈 (He/They) @JncherabieMD]

Now for implementation:
We still don't know the best way to implement currently with pros and cons for broader and more restrictive use
Counseling points included below but also need to discuss risk of AMR and side effects

[Joseph Cherabie MD, MSc 🏳️‍🌈 (He/They) @JncherabieMD]

And lest we not forget, doxycycline is effective against Staph aureus, and increased use can increase resistance to Staph aureus (subclinical resistance present)

[Joseph Cherabie MD, MSc 🏳️‍🌈 (He/They) @JncherabieMD]

As for Mycoplasma genitalium, 11% in Ipergay had Mgen, we know there are high rates of resistance to macrocodes and increasing to quinolone, with doxycycline being the alternative, something to definitely keep in the back of our minds and again need more data for all of these

[Joseph Cherabie MD, MSc 🏳️‍🌈 (He/They) @JncherabieMD]

Doxycycline is important for chalmydia, syphilis, and Mycoplasma genitalium, with resistance needing to be followed closely.
Not much data on chlamydia and syphilis resistance, theoretical potential of syphilis resistance to doxy but still primary non-betalactam

[Joseph Cherabie MD, MSc 🏳️‍🌈 (He/They) @JncherabieMD]

What about antimicrobial resistance?? We know gonorrhea has developed resistance to everything we have thrown at it, with azithromycin serving as a cautionary tale

[Joseph Cherabie MD, MSc 🏳️‍🌈 (He/They) @JncherabieMD]

Now how will Doxy PEP affect the microbiome??
MSM who have receptive anal sex have enriched Prevotella microbiome, lube also affects microbiome.
Not many studies on Doxycycline and its effect on microbiome

[Joseph Cherabie MD, MSc 🏳️‍🌈 (He/They) @JncherabieMD]

Gonococcal Tetracycline susceptibility - baseline 25% TCN resistance, but still saw results which is interesting. Still would resistance increase with more Doxy PEP use?? More research needed

[Joseph Cherabie MD, MSc 🏳️‍🌈 (He/They) @JncherabieMD]

Participants typically took 16 doses per month based on pill count, majority took <10 doses/month. No change in sex partners, condoles sex, or risk compensation.

[Joseph Cherabie MD, MSc 🏳️‍🌈 (He/They) @JncherabieMD]

Amazing results with Doxy PEP, 65% reduction in STIs per quarter, 55-57% reduction in GC, 74-88% reduction in CT, and 87% reduction in syphilis (only significant among PrEP but not much baseline syphilis)

[CNWL Sexual Health @CNWLSexHealth]

We have opened up more slots for the Monkeypox vaccination at Mortimer Market Centre today. Take a look at our bookable appointments for eligible patients here: https://t.co/CaX99mVi3k @MMC_cnwl

[Michael Marks @dr_michaelmarks]

#IUSTI2022 Whole-genome sequencing now main steam for gonorrhea #AMR in high-income settings see e.g @LancetMicrobe from USA https://t.co/Nu5gMjsvGx 1/2

[rachel baggaley @rbaggaley]

lack of cheap "true" PoC tests for STIs barrier to effective programming - Jeffrey Klausner presenting at IUSTI exciting preliminary result from @FIND for GC lat flow @DrJasonJOng @ccasejohn @mylittlebaklava

[rachel baggaley @rbaggaley]

@mdoherty_hiv at IUSTI calling for research and development for STI vaccines & the launch of a new website https://t.co/v3DahEo7dO - a joint effort from @HIVpxresearch @NIAIDNews and @WHO

[Prof Jackie Cassell @jackiecassell]

@DewsnapClaire "This outbreak of this clade/lineage has been overwhelmingly sexually transmitted" I think a better description. Same clade in other circumstances might not be. It's not all in the pathogen...