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Doxycycline Prophylaxis to Reduce Incident Syphilis among HIV-Infected Men Who Have Sex With Men Who Continue to Engage in High-Risk Sex: A Randomized, Controlled Pilot Study
Open accessAbstract
BACKGROUND: Incident syphilis infections continue to be especially prevalent among a core group of HIV-infected men who have sex with men (MSM). Because of synergy between syphilis and HIV infections, innovative means for controlling incident syphilis infections are needed. METHODS: Thirty MSM who had syphilis twice or more since their HIV diagnosis were randomized to receive either daily doxycycline prophylaxis or contingency management (CM) with incentive payments for remaining free of sexually transmitted diseases (STDs). Participants were tested for the bacterial STDs gonorrhea (Neisseria gonorrhoeae), chlamydia (Chlamydia trachomatis) and syphilis at weeks 12, 24, 36, and 48 and completed a behavioral risk questionnaire during each visit to assess number of partners, condom use, and drug use since the last visit. Generalized linear mixed models were used to analyze differences between arms in STD incidence and risk behaviors at follow-up. RESULTS: Doxycycline arm participants were significantly less likely to test positive for any selected bacterial STD during 48 weeks of follow-up (odds ratio, 0.27; confidence interval, 0.09-0.83) compared with CM arm participants (P = 0.02).There were no significant self-reported risk behavior differences between the doxycycline and CM arms at follow-up. CONCLUSIONS: Daily doxycycline taken prophylactically was associated with a decreased incidence of N. gonorrhoeae, C. trachomatis, or syphilis incident infections among a core group of HIV-infected MSM at high risk for these infections. Safe and effective biomedical tools should be included in the efforts to control transmission of syphilis, especially in this population. A randomized clinical trial should be conducted to confirm and extend these findings.
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“That study demonstrated a 73% reduction in any bacterial STI at any site, without substantial differences in sexual behavior.”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [90]
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“Doxycycline taken as STI PrEP as 100 mg orally once daily also demonstrated a substantial reduction in gonorrhea, chlamydia, and syphilis among MSM (90).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [90]
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Liu, C., Bayer, A. S., Cosgrove, S. E., Daum, R. S., Fridkin, S. K., Gorwitz, R. J., Kaplan, S. L., Karchmer, A. W., Levine, D. P., Murray, B. E., et al. (2011) · Clinical Infectious Diseases · doi:10.1093/cid/ciq146 · Cited by 4,260
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Self-citationDynamics and Control of the Transmission of Gonorrhea
Yorke, J. A., Hethcote, H. W., & Nold, A. (1978) · Sexually Transmitted Diseases · doi:10.1097/00007435-197804000-00003 · Cited by 418
An Efficacy Trial of Doxycycline Chemoprophylaxis against Leptospirosis
Takafuji, E. T., Kirkpatrick, J. W., Miller, R. N., Karwacki, J. J., Kelley, P. W., Gray, M. R., McNeill, K. M., Timboe, H. L., Kane, R. E., & Sánchez, J. L. (1984) · New England Journal of Medicine · doi:10.1056/nejm198402233100805 · Cited by 312
HIV transmission rates from persons living with HIV who are aware and unaware of their infection
Hall, H. I., Holtgräve, D. R., & Maulsby, C. H. (2012) · AIDS · doi:10.1097/qad.0b013e328351f73f · Cited by 291
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Self-citationSex Affects the Steady-State Pharmacokinetics of Primaquine but Not Doxycycline in Healthy Subjects
Binh, V. Q., Chinh, N. T., Thanh, N. X., et al. (2009) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2009.09-0214 · Cited by 43
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Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 3,018
Molina, J.-M., Charreau, I., Chidiac, C., Pialoux, G., Cua, E., Delaugerre, C., Capitant, C., Rojas-Castro, D., Fonsart, J., Bercot, B., et al. (2018) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(17)30725-9 · Cited by 449
Responding to global stimulant use: challenges and opportunities
Farrell, M., Martin, N. K., Stockings, E., Bórquez, A., Cepeda, J. A., Degenhardt, L., Ali, R., Tran, L. T., Rehm, J., Torrens, M., et al. (2019) · The Lancet · doi:10.1016/s0140-6736(19)32230-5 · Cited by 310
Confronting Rising STIs in the Era of PrEP and Treatment as Prevention
Ramchandani, M. S., & Golden, M. R. (2019) · Current HIV/AIDS Reports · doi:10.1007/s11904-019-00446-5 · Cited by 84
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Metadata
- Authors
- Bolan, R. K., Beymer, M. R., Weiss, R. E., Flynn, R. P., Leibowitz, A. A., & Klausner, J. D.
- Affiliations
- University of California, Los Angeles (US)
- Los Angeles LGBT Center (US)
- Corresponding author
- Bolan, Robert K.
- Beymer, Matthew R.
- Flynn, Risa P.
- ORCID
- Venue
- Sexually Transmitted Diseases
- Published
- 2015-02
- Volume
- 42
- Issue
- 2
- Pages
- 98-103
- ISSN
- 0148-5717 (ISSN-L)
- PMC
- PMC4295649
- OpenAlex
- W2149986546
- Cited by
- 206
- References
- 11
- Citations by year
- 2026: 14 · 2025: 30 · 2024: 33 · 2023: 36 · 2022: 16 · 2021: 15 · 2020: 13 · 2019: 18 · 2018: 11 · 2017: 10 · 2016: 5 · 2015: 4
- FWCI
- 7.37
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Sexually Transmitted Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR000124)
- U.S. Public Health Service (5P30 A1028697)
- National Institute of Mental Health (MH58107, P30MH058107)
- National Institute of Allergy and Infectious Diseases (P30AI028697)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Infectious Diseases › Syphilis Diagnosis and Treatment
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- doxycycline prophylaxis, syphilis incidence, HIV-infected men who have sex with men, contingency management, sexually transmitted infections, gonorrhea, chlamydia, condom use, sexual risk behavior, HIV-syphilis coinfection
- MeSH terms
- Adult, Anti-Bacterial Agents, Doxycycline, Feasibility Studies, Humans, Health Knowledge, Attitudes, Practice, Male, Pilot Projects, Reimbursement, Incentive, Risk-Taking, Sexual Partners, Syphilis, Los Angeles, HIV Infections, Incidence, Prevalence, Condoms, Homosexuality, Male, Pre-Exposure Prophylaxis
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