Antimicrobial use for the treatment of bacterial sexually transmitted infections among doxycycline post-exposure prophylaxis (DoxyPEP) users in Milan, Italy-right-to-reply

Dear Editor, We would like to thank our Italian colleagues, Bortolani et al.1, for their thoughtful comments on our manuscript regarding the use of doxycycline post-exposure prophylaxis (DoxyPEP) in Milan. The authors rightly emphasise that the clinical potential of DoxyPEP must be balanced against antimicrobial stewardship and implementation realities. We agree that, in the absence of clear governance, uneven uptake and unsupervised use can occur, and that both clinicians and users deserve consistent, evidence-based guidelines and a shared decision-making process. In our view, the central question for health systems is no longer whether DoxyPEP can reduce bacterial sexually transmitted infections (STIs) in specific high-incidence networks, but rather how it can be implemented successfully and responsibly. We believe the answer lies in targeted access within comprehensive sexual health services, structured routine counselling, and ongoing resistance-related surveillance. These measures are feasible, scalable, and compatible with stewardship, and they transform an individual-level prevention tool into a programme that could be safe for populations.