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Lancet Infect Dis. 2018 Mar;18(3):308-317. doi: 10.1016/S1473-3099(17)30725-9. Epub 2017 Dec 8.

Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial.

Author information

1
Department of Infectious Diseases, Paris, France; Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Université de Paris Diderot Paris 7, Sorbonne Paris Cité, and INSERM UMR 941, Paris, France. Electronic address: jean-michel.molina@aphp.fr.
2
INSERM SC10 US19, Villejuif, France.
3
Department of Infectious Diseases, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
4
Department of Infectious Diseases, Hôpital Tenon, Paris, France.
5
Department of Infectious Diseases, Hôpital de l'Archet, Centre Hospitalier de Nice, Nice, France.
6
Laboratory of Microbiology, Paris, France; Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Université de Paris Diderot Paris 7, Sorbonne Paris Cité, and INSERM UMR 941, Paris, France.
7
Association AIDES, Pantin, Paris, France.
8
Biochemistry Laboratory, Paris, France.
9
Laboratory of Microbiology, Paris, France; IAME UMR1137, Paris, France.
10
Bacteriology Department, French National Center for Bacterial Sexually Transmitted Infections, CHU de Bordeaux, and USC EA 3671, University of Bordeaux, Bordeaux, France.
11
Department of Infectious Diseases, Hôpital Gustave Dron, Centre Hospitalier Universitaire de Tourcoing, Tourcoing, France.
12
Department of Infectious Diseases, CHU de Nantes and CIC 1413, INSERM, Nantes, France.
13
Department of Infectious Diseases, Paris, France.
14
Aix Marseille University, INSERM IRD SESSTIM, Marseille, France.
15
France Recherche Nord & Sud Sida-HIV Hépatites (ANRS), Paris, France.
16
INSERM SC10 US19, Villejuif, France; Université Paris Sud Paris Saclay, Paris, France.

Abstract

BACKGROUND:

Increased rates of sexually transmitted infections (STIs) have been reported among men who have sex with men. We aimed to assess whether post-exposure prophylaxis (PEP) with doxycycline could reduce the incidence of STIs.

METHODS:

All participants attending their scheduled visit in the open-label extension of the ANRS IPERGAY trial in France (men aged 18 years or older having condomless sex with men and using pre-exposure prophylaxis for HIV with tenofovir disoproxil fumarate plus emtricitabine) were eligible for inclusion in this open-label randomised study. Participants were randomly assigned (1:1) at a central site to take a single oral dose of 200 mg doxycycline PEP within 24 h after sex or no prophylaxis. The primary endpoint was the occurrence of a first STI (gonorrhoea, chlamydia, or syphilis) during the 10-month follow-up. The cumulative probability of occurrence of the primary endpoint was estimated in each group with the Kaplan-Meier method and compared with the log-rank test. The primary efficacy analysis was done on the intention-to-treat population, comprising all randomised participants. All participants received risk-reduction counselling and condoms, and were tested regularly for HIV. This trial is registered with ClinicalTrials.gov number, NCT01473472.

FINDINGS:

Between July 20, 2015, and Jan 21, 2016, we randomly assigned 232 participants (n=116 in the doxycycline PEP group and n=116 in the no-PEP group) who were followed up for a median of 8·7 months (IQR 7·8-9·7). Participants in the PEP group used a median of 680 mg doxycycline per month (IQR 280-1450). 73 participants presented with a new STI during follow-up, 28 in the PEP group (9-month probability 22%, 95% CI 15-32) and 45 in the no-PEP group (42%, 33-53; log-rank test p=0·007). The occurrence of a first STI in participants taking PEP was lower than in those not taking PEP (hazard ratio [HR] 0·53; 95% CI 0·33-0·85; p=0·008). Similar results were observed for the occurrence of a first episode of chlamydia (HR 0·30; 95% CI 0·13-0·70; p=0·006) and of syphilis (0·27; 0·07-0·98; p=0·047); for a first episode of gonorrhoea the results did not differ significantly (HR 0·83; 0·47-1·47; p=0·52). No HIV seroconversion was observed, and 72 (71%) of all 102 STIs were asymptomatic. Rates of serious adverse events were similar in the two study groups. Gastrointestinal adverse events were reported in 62 (53%) participants in the PEP group and 47 (41%) in the no-PEP group (p=0·05).

INTERPRETATION:

Doxycycline PEP reduced the occurrence of a first episode of bacterial STI in high-risk men who have sex with men.

FUNDING:

France Recherche Nord & Sud Sida-HIV Hépatites (ANRS) and Bill & Melinda Gates Foundation.

PMID:
29229440
DOI:
10.1016/S1473-3099(17)30725-9
[Indexed for MEDLINE]

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