Letter to Senator Rubio on Doxy PEP

Dear Senator Rubio,

The Florida Chapter of the American Academy of HIV Medicine wishes to address your March 11, 2024 press release and accompanying letter to the CDC related to doxycycline post-exposure prophylaxis (Doxy PEP) to prevent bacterial sexually transmitted infections (STIs).

The ten-year trend of STIs in Florida reveals an epidemic increasing at an alarming rate.

	2011 Cases in Florida	2022 Cases in Florida
Chlamydia	27,888	106,873
Gonorrhea	19,695	44,333
Infectious Syphilis	1,257	4,618
Congenital Syphilis	33	181

flhealthcharts.gov Bacterial STD rates in Florida accessed 13MAR2024

At a time when Florida’s best public health efforts to date have not achieved a reduction in new STIs, we feel it is of utmost importance to advise you that data are in existence supporting the preventive practice of Doxy PEP.

Many studies are ongoing with new data continuing to be reported supporting Doxy PEP practice despite the risk of antimicrobial resistance developing. The most recent study reported at the Conference on Retroviruses and Opportunistic Infections (CROI) concluded that “modest changes in doxy-R S. aureus and Neisseria spp [related to potential antimicrobial resistance] are unlikely to have clinical significance and must be considered in context of >60% STI reduction with Doxy PEP.” Ongoing studies continue to monitor and assess the risk.

Senator Rubio, the use of Doxy PEP is a decision made by a licensed practitioner using shared decision making with their patient. This is an evidence based and efficacious use of an antibiotic. When considering the rising epidemic of STIs in Florida, Doxy PEP is an important tool needed to protect Floridians and poses a potential benefit to Florida in reducing STIs.