Health Professionals Update – Vol. 19, No. 8

March 19, 2026

From:
Dr. Gayane Hovhannisyan, MD, MPH, PhD, FRCPC, AMOH

In this issue

Recommendations on the use of doxycycline post‑exposure prophylaxis (Doxy-PEP) for cisgender gay, bisexual and other men who have sex with men (GBMSM) and transgender women.

Key messages

The National Advisory Committee on Sexually Transmitted and Blood-Borne Infections (NAC-STBBI) has issued recommendations supporting the use of Doxy-PEP for GBMSM and transgender women at “increased risk” of bacterial sexually transmitted infections (STIs).
Recommended regimen: Doxycycline 200 mg taken within 72 hours after exposure; maximum of one dose (200 mg) per 24‑hour period.
Use a shared decision‑making approach that includes clear review of benefits, risks, and antimicrobial resistance considerations.

Recommendations on the use of Doxy-PEP for GBMSM and transgender women

Syphilis, chlamydia, and gonorrhea disproportionately impact certain groups and communities, such as GBMSM and transgender women.

Evidence indicates that, among GBMSM and transgender women, doxycycline 200 mg taken within 72 hours after exposure reduces the incidence of syphilis and chlamydia, with lower effectiveness against gonorrhea depending on local tetracycline resistance.

Offer Doxy-PEP to GBMSM and transgender women at increased risk of bacterial STIs

NAC‑STBBI recommends offering Doxy-PEP to GBMSM and transgender women who are at increased risk of bacterial STIs.

Clinical judgment should guide assessment of risk. Factors that can increase an individual's risk of bacterial STI include, but are not limited to:

recent prior bacterial STI(s),
having 10 or more partners in the last 6 months,
condomless sex with multiple partners,
engaging in "chemsex" (using stimulants during sex e.g. crystal methamphetamine), and/or
engaging in group sex.

Recommended regimen for Doxy-PEP

Doxycycline 200 mg orally, taken within 72 hours of exposure (i.e., condomless oral, vaginal or anal sex).
No more than 1 dose (200 mg) in a 24-hour period.
Prescriptions are given in advance for self-administration (as needed) and should account for enough doses based on the patient’s anticipated sexual activity until their next visit.
If a Doxy-PEP user has multiple sexual partners during a period of 2-3 consecutive days (e.g. a weekend), a single dose of 200 mg Doxy-PEP at the end of the 72-hour period (e.g. on Monday morning after the weekend) should be adequate.

Note: The use of doxycycline as prophylaxis against bacterial STIs is an off-label use.

Use shared decision‑making for all Doxy‑PEP discussions

When discussing Doxy-PEP, use a shared decision‑making approach that includes clear review of benefits, risks, and antimicrobial resistance considerations.
To inform shared decision-making, the NAC-STBBI recommends discussing personal, community (e.g., GBMSM) and population-level risks of antimicrobial resistance with individuals considering this intervention

Monitoring and follow-up

Doxy-PEP should be part of a holistic and comprehensive sexual health approach.
The use of Doxy-PEP should be reassessed every three to six months as an individual's risk may change over time.
Follow PHAC's STBBI guides for health professionals for STI screening, testing and management.

Antimicrobial resistance

Evidence is emerging on the impacts of Doxy-PEP use on antimicrobial resistance. The extent and clinical significance of these effects are uncertain.
Doxy-PEP may not be very effective for preventing gonorrhea in Canada due to high levels of resistance in gonorrhea to tetracyclines, including doxycycline, especially among GBMSM.
Doxy-PEP use is likely to increase tetracycline resistance in gonorrhea and may increase multidrug resistance (MDR) in gonorrhea.
Doxy-PEP use may increase tetracycline resistance and MDR in other bacteria (e.g., Staphylococcus aureus, Shigella spp.)

More information

Contact us

The Health Professionals Update (HPU) is distributed to physician offices in Peel region via fax or email. Share this update with other health professionals in your clinic.

More information:

For questions about this update, email healthprofessionals@peelregion.ca.