The World Health Organisation (WHO) has released its first-ever recommendation on the use of doxycycline Post-Exposure Prophylaxis (doxyPEP) for preventing bacterial Sexually Transmitted Infections (STIs) among men who have sex with men and transgender women. The recommendation follows a comprehensive guideline development process and is based on growing evidence demonstrating the effectiveness of doxycycline when taken after sexual exposure.

According to WHO, doxyPEP has been shown to significantly reduce the risk of syphilis and chlamydia infections and may also help lower the incidence of gonorrhoea in certain settings. The guidance comes at a time when bacterial STIs continue to rise globally, particularly among populations that face a disproportionately higher burden of infection.

Dr. Tereza Kasaeva, Director of WHO’s Department for HIV, TB, Hepatitis and STIs, said the recommendation represents an important advancement in expanding prevention options for at-risk communities. She emphasised the need for countries and healthcare partners to work together to implement the new guidance and ensure access to evidence-based prevention tools for vulnerable populations.

WHO stressed that the use of doxyPEP should be integrated into a comprehensive sexual health strategy, with priority given to individuals experiencing recent or recurrent STIs, particularly syphilis. The organisation also highlighted the importance of monitoring antimicrobial resistance and adapting implementation approaches based on local contexts.

The recommendation aligns with commitments under WHO’s Global Health Sector Strategies on HIV, viral hepatitis and STIs, as well as broader international goals related to Universal Health Coverage. Despite ongoing efforts to improve prevention and healthcare access, STI rates continue to increase in many regions, with men who have sex with men and transgender women remaining among the most affected groups.

WHO noted that factors contributing to the continued rise in STIs include limited prevention options beyond condom use, barriers to accessing comprehensive healthcare services, persistent stigma and discrimination and insufficient integration of STI prevention into HIV and broader healthcare programmes.

To support implementation, WHO plans to conduct a series of webinars and share updates through its Knowledge Sharing Platform. The organisation has also encouraged national STI programmes and healthcare stakeholders to consult WHO before introducing doxyPEP in accordance with the new guidance.

A detailed guideline, including evidence summaries and decision-making frameworks developed using the GRADE methodology, will be published on the WHO website in the coming months and incorporated into WHO’s consolidated STI guidelines. The publication will also include implementation resources and key recommendations to assist countries in adopting the new preventive approach.