CDC tells US public to take a post-sex pill to tackle explosion of STIs

Americans should take a pill after sex to tackle America’s explosion in sexually transmitted infections (STIs), health officials say.

The Centers for Disease Control and Prevention (CDC) is urging singletons to use doxycycline as a ‘morning-after pill’ to prevent preventing bacteria from reproducing and developing into an infection.

The cheap antibiotic — that costs around $1.18 per pill, has been used for more than 50 years to treat dental infections and skin conditions.

It comes in response to what the CDC has described as an ‘STI epidemic’, with a record 2.53million cases of chlamydia, gonorrhea and syphilis in 2021.

The 2021 figures – revealed in a report this week- marks a 6 percent rise on the figure in 2020 and a 7 percent increase on 2017.

Some STIs, such as syphilis, are seeing the highest numbers in more than 70 years.

Dr Leandro Mena, director of the CDC’s STD prevention division, believes doxycycline could act as a ‘morning after’ pill for sexually transmitted infections, able to prevent STDs within 72 hours of having unprotected sex.

The antibiotic is used to treat other bacterial infections such as acne and malaria.

When taken within three days after unprotected sex, it reduces infections by more than 60 percent by preventing bacteria from reproducing.

It does this by inhibiting bacterial protein synthesis, meaning amino acids cannot be linked together. Without proteins, bacteria are unable to function.

Currently, the medication is not available over-the-counter and patients need a prescription from their doctor to get the tablets at $1.18 each.

Dr Mena said the CDC is drafting recommendations for using doxycycline in this way. 

New data published in the New England Journal of Medicine last week regarding doxycycline is giving doctors some measure of hope that the epidemic of STIs could be curtailed.

In the study funded by the National Institutes of Health, 501 gay men, bisexual men and transgender women in Seattle and San Francisco with a history of STD infections took one doxycycline pill within 72 hours of unprotected sex.

Researchers refer to this course of treatment in the study as doxycycline postexposure prophylaxis, or doxyPEP for short.

During 2020 to 2021, the gonorrhea rate among men increased more than six percent (from 234.8 to 249.7 per 100,000) and the rate among women increased over two percent (from 173.8 to 177.9 per 100,000)

Chlamydia was not reportable in all 50 states and the District of Columbia until 2000. Steady increases in chlamydia case rates beginning in 1996 are due in part to improved reporting and testing infrastructure 

In 2021, there were a total of 2,855 cases of congenital syphilis reported for a rate of about 78 per 100,000 live births. During 2020 to 2021, the rate of reported congenital syphilis increased more than 30 percent

Participants who took the pills were about 90 percent less likely to get chlamydia, 80 percent less likely to get syphilis, and more than 50 percent less likely to get gonorrhea compared with people who did not take the pills after sex.

Doctors at the University of California, San Francisco and the University of Washington said: ‘The combined incidence of gonorrhea, chlamydia, and syphilis was lower by two thirds with doxycycline postexposure prophylaxis than with standard care, a finding that supports its use among [men who have sex with men] with recent bacterial STIs.’

Dr Philip Andrew Chan, who is consulting with the CDC on the doxycycline recommendations, said that using an antibiotic to prevent STDs will not be ‘a magic bullet’ but it ‘will be another tool’.

The San Francisco Department of Public Health endorsed doxycycline’s use as a prophylactic in October last year, citing research carried out in Washington and California. 

The department said last fall: ‘Doxy-PEP is the first biomedical prevention tool that has been shown to be effective and well-tolerated, community awareness is growing, and many providers in SF are already prescribing doxy-PEP to their patients at risk for STIs.’

Meanwhile, the CDC’s Dr Mena said there is no sign of the STD trend slowing.

Officials have blamed limited access to healthcare during the pandemic and increasingly lax attitudes towards contraception.

There were 2.53 million cases of chlamydia, gonorrhea and syphilis in 2021, according to the CDC, up almost 6 percent from the figure in 2020 and a 7 percent increase on 2017.

While certain STIs were still not as high in 2021 and in pre-pandemic years, other, such as syphilis, are seeing the highest numbers in more than 70 years.

Half (50.5 percent) of reported cases of STDs were among adolescents and young adults aged 15–24 years in 2021.

Those aged 20-24 had the highest rates of gonorrhea (873 and 844 respectively per 100,000 population), followed by males aged 25-29 and 30-34.

For chlamydia, females aged 20-24 and 15-19 had the highest rates (3798 and 2697 per 100,000 population), followed by men ages 20-24.

With primary and secondary syphilis, men in every age group had a higher rate than women, with the highest in males aged 25-29 with a rate of 68 per 100,000 population.

The CDC figures show there were 176,713 syphilis cases in 2021, the highest since the 217,558 cases reported in 1950 and up a third on 2020.

The report also found a surge in congenital syphilis, which happens when a baby is born with the infection after catching it from her mother during pregnancy.

Cases rose by 32 percent from 2,148 in 2020 to more than 2,800 in 2021. This resulted in 220 stillbirths and infant deaths in 2021, the CDC said. 

Cases of gonnhorea rose nearly five percent from 2020 to 2021, from 677,769 cases to more than 710,000, the highest yearly total in four years.

Chlamydia cases, which were more common to begin with at 1,579,885 in 2020 shot up to 1,644,416 in 2021. 

Despite this roughly four percent increase, total yearly cases of chlamydia have declined since 2019 when more than 1.8 million cases were reported.