OBJECTIVE: To examine the awareness, usage and perceptions of doxycycline post-exposure prophylaxis (doxyPEP) for sexually transmitted infection (STI) prevention among gay and bisexual men and transgender (trans) and gender diverse people in Australia.
DESIGN: Cross-sectional online survey.
SETTING, PARTICIPANTS: National multi-site survey in Australia from 1 July 2024 to 30 November 2024, recruiting from 13 sexual health and community clinics, 6 general practices, social media, dating applications, and university portals. Gay and bisexual men and trans and gender diverse people aged ≥ 18 years living in Australia were included in the study.
MAIN OUTCOME MEASURES: DoxyPEP awareness, ever use, recent use (past 12 months), dosage regimens, sourcing methods and planned future use.
RESULTS: Among 2095 participants, half (1080/2095, 51.6%) had heard of doxyPEP. Of those aware, 323/1080 (29.9%) had ever used doxyPEP, and 306/1080 (28.3%) were recent users. DoxyPEP awareness and usage varied by HIV status and pre-exposure prophylaxis (PrEP) use (p < 0.0001). Nearly two-thirds of users had taken the recommended 200 mg within 72 h after sex (205/323, 63.5%). Among recent users, 29/306 (9.5%) reported recent syphilis diagnoses, and 85/306 (27.8%) had ≥ 2 STI diagnoses in the past 12 months. Of those who had ever used doxyPEP, 135/323 (41.8%) obtained prescriptions from clinicians, 17/323 (5.3%) obtained it online, and 28/323 (8.7%) purchased it in person overseas without a prescription. Of those aware of doxyPEP, 490/1080 (45.4%) planned to use doxyPEP in the next 12 months, primarily to prevent chlamydia (460/490, 93.9%), gonorrhoea (422/490, 86.1%) or syphilis (386/490, 78.8%). Some intended to prevent Mycoplasma genitalium (92/490, 18.8%) or mpox (36/490, 7.4%). Among non-users, 306/756 (40.5%) worried about antibiotic resistance.
CONCLUSIONS: DoxyPEP use was happening quickly but often involved non-recommended regimens and unsupervised sourcing. Urgent educational interventions and improved clinical access are needed for safe implementation.
The Known: Doxycycline post‐exposure prophylaxis (doxyPEP) reduces bacterial sexually transmitted infections by 53% in men who have sex with men and in transgender women. A 2023 Australian consensus statement recommends doxyPEP primarily for those with recent syphilis or multiple diagnoses. The New: In a national survey of 2095 participants, 51.6% had heard of doxyPEP, of which one‐third had ever used it. One‐third used non‐recommended regimens, one in seven sourced it without a prescription, and situational risk factors mainly drove usage. The Implications: Clinicians and health departments should prioritise education, supervised access and stewardship to align community practice with guidance and strengthen antimicrobial resistance monitoring.