Brief Report: Optimizing STI Prevention: Barriers, Behaviors, and Broader Impacts of Doxycycline Postexposure Prophylaxis (DoxyPEP)

BACKGROUND: Doxycycline postexposure prophylaxis (DoxyPEP) is a novel strategy for preventing sexually transmitted infections (STIs). Although its clinical efficacy is established, less is known about its implementation, accessibility, and associated behavioral adaptations. This study evaluated these factors at the University of Miami Rapid Access Wellness clinic, which offers preexposure prophylaxis, non-occupational post-exposure prophylaxis (nPEP), HIV care, and, since May 2023, DoxyPEP. METHODS: From February to November 2024, clients at the Rapid Access Wellness Clinic were recruited to complete electronic surveys assessing DoxyPEP awareness, barriers, behaviors, and satisfaction. Survey responses were linked to medical records for analysis. RESULTS: Among 135 participants (mean age 36 years), 77% identified as men, 16% as transgender, 69% as Hispanic/Latino, and 13% as Black/African American. The median number of sexual partners at intake was 5. DoxyPEP awareness was high (89%), with 77% actively using it. Most felt comfortable discussing DoxyPEP with doctors (92%), friends (60%), and sexual partners (55%). Cost was not a reported barrier for 68%. Nearly half (46%) reported behavioral changes because of DoxyPEP, including increased sexual partners (20%), reduced condom use (17%), and more anal sex (15%). More than half (55%) felt less concerned about STI exposure. Most (90%) were likely to discuss DoxyPEP with others, with 84% having already recommended it, primarily to friends (67%). In total, 94% planned to continue its use. CONCLUSIONS: DoxyPEP was widely accepted, accessible, and frequently promoted through peer networks, indicating a potential mechanism for broadening awareness of DoxyPEP among priority populations. Further study of associated behavioral changes may help optimize its role in STI prevention.