Guideline on doxycycline post-exposure prophylaxis for sexually transmitted infections among men who have sex with men and transgender women

Overview

This guideline provides evidence-informed recommendations on the use of doxycycline post-exposure prophylaxis (PEP) for the prevention of bacterial sexually transmitted infections (STIs) among men who have sex with men and transgender women, populations disproportionately affected by STIs. It presents WHO’s first recommendation on this intervention, developed through systematic review of the available evidence and expert assessment of its benefits, harms, acceptability, feasibility, equity and implementation considerations. The guideline recommends that doxycycline PEP may be offered as part of a comprehensive sexual health package, while emphasizing the importance of monitoring antimicrobial resistance during policy implementation.

The document summarizes the evidence supporting the recommendation, outlines its justification, and provides practical guidance for implementation, including timing of doxycycline use, prioritization of individuals at higher STI risk, integration into sexual health services, equitable service delivery models, and monitoring and evaluation. It also identifies key research gaps, particularly regarding antimicrobial resistance, population-level impact, optimal dosing strategies, integrated service delivery models and implementation research, to inform future policy development and strengthen evidence-based STI prevention.