Closing the education gap in DoxyPEP implementation and STI-related non-prescription antibiotic use

Background

Risk-based STI prevention requires people to recognise exposure, understand indications, and seek testing and counselling. As DoxyPEP becomes more visible, emerging evidence indicates both inappropriate patterns of doxycycline use, including non-recommended regimens or use outside clinical guidance, and broader STI-related antibiotic self-medication. This creates an education gap: people may confuse structured prophylaxis with informal antibiotic use, potentially delaying diagnosis, reducing counselling opportunities and challenging antimicrobial stewardship.

Objectives

To develop a transferable education and outreach framework supporting safer DoxyPEP implementation and reducing STI-related non-prescription antibiotic use across clinical, community, pharmacy and digital settings.

Results

The framework includes five priorities: clear messages on when DoxyPEP is appropriate and why antibiotics are not interchangeable; co-designed education with LGBTQIA+ organisations to increase trust and reduce stigma; digital and dating-app outreach to reach people outside sexual health services; inclusion of behavioural indicators on informal antibiotic use in research and surveillance; and pharmacy-based referral to STI testing and counselling when antibiotics are requested for possible STI exposure. Community data informing the framework suggest that DoxyPEP experience may involve about one fifth of respondents in some samples, while STI-related antibiotic self-medication may affect about one in ten, supporting the need for targeted education beyond clinic-based pathways.

Conclusions

Safe DoxyPEP implementation depends on health literacy, counselling and linkage to care, not only medication access. Addressing the grey zone between prevention and misuse through community, digital and pharmacy education may strengthen STI prevention, reduce hidden antibiotic misuse and support antimicrobial stewardship.

Key messages

• Safe DoxyPEP implementation requires education that clearly separates evidence-based prophylaxis from unsupervised antibiotic self-medication.

• Community, digital, and pharmacy-based outreach can reach people who remain outside STI services and reduce invisible antibiotic misuse.