- Automatic translation

In 2023, notifications increased by 16% for chlamydia, 138% for gonorrhea, and 53% for syphilis compared with 2019.

The situation of sexually transmitted infections in Iceland

In 2023, the incidence of gonorrhea had increased by 159% and the incidence of syphilis by 78% compared with 2019. There was no increase in the incidence of chlamydia during the same period, but approximately 2,000 cases of chlamydia are diagnosed in Iceland each year.

What is doxy-PEP?

The European Centre for Disease Prevention and Control (ECDC) recently issued guidance regarding the use of the antibiotic doxycycline, so-called doxy-PEP, as preventive treatment against sexually transmitted infections in individuals at high risk.

Who may benefit from the treatment?

The ECDC does not recommend the general use of doxy-PEP, but rather an individualized approach for those at higher risk of acquiring sexually transmitted infections. When considering this treatment, an individual assessment should determine who may benefit, and it is recommended that such an assessment take place in conjunction with other sexual health measures such as regular STI testing, vaccinations, HIV prevention, and contact tracing.

Benefits of the treatment

The ECDC guidance focuses on prevention among those at greatest risk. Studies have shown that this treatment may help prevent chlamydia and syphilis in men who have sex with men and transgender women with a prior history of sexually transmitted infections. However, the treatment is unlikely to prevent gonorrhea, as approximately 58% of gonorrhea bacteria are currently resistant to the medication.

Risks of the treatment

Excessive antibiotic use may increase antibiotic resistance in the future, which can complicate the treatment of sexually transmitted infections as well as other diseases, such as infections caused by Staphylococcus aureus. Increased antibiotic resistance means that it becomes more difficult to use standard antibiotics to treat infections, and in some cases, no antibiotics may be effective. Users of this treatment must also be informed about side effects, long-term safety, and the risk of developing antibiotic resistance both at the individual and community level.

Summary

If doxy-PEP is implemented, it should be linked with other preventive measures and primarily targeted at preventing syphilis, possibly chlamydia, but not gonorrhea, and particularly for those at highest risk of infection. Users must be informed about the benefits and potential risks, including uncertainty regarding long-term safety and the possible development of antibiotic resistance. Regular reassessment of each individual’s use is recommended. Active surveillance of the impact of doxy-PEP on STI incidence, antibiotic use, and the emergence of antibiotic resistance is essential.

Further information and the full guidance can be found on the website of the European Centre for Disease Prevention and Control (ECDC).

The Chief Epidemiologist