John Saunders

@manik_psk @SF_DPH @BASHH_UK @DrWillN @TeamPrepster @UKHSA @drlaurajwaters @CDCSTD I am so worried about doxy p(r)ep. These guidelines are lacking in AMR info even tho the trial showed doubling of NG resistance. Likely doxy will effect commensals (bit.ly/3TK4MRs) ➡️more deaths due to AMR (bit.ly/3VShbES). @JHocking01 @MicroDx_UQ

Our very own @manik_psk was invited to present on doxycycline as prophylaxis for STIs at the @IUSTI_Europe conference @BASHH_UK seminar today. He highlighted the BASHH position statement & recent statement/guideline update from @CDCgov @CDCSTD

Abstracts due 15 January! STI&HIV 2023 World Congress in Chicago 24-27 July 2023. @ProfKevinFenton, Dr. Leandro Mena, Dr. Teo Wi on the stage. Cutting-edge talks on trust in science, health inequalities, sexual rights, AMR, community engagement, and MORE! #STIHIV2023

@JncherabieMD @saunders_j But the recent DoxyPrep found a doubling of Tc resistance in the doxy arm but not In control arm - so AMR is occurring. I’m more concerned about commensal AMR Eg S.aureus that can kill then for GC per se.

DoxyPEP should most definitely be integrated in HIV PrEP and HIV ART services!!

Other implementation considerations: Doxycycline is affordable out of pocket! Lab monitoring is more difficult (as always) - consider CBC, renal, and liver function test monitoring periodically (every 6 months? annually?) STI screening every 3-6 months?

Now for implementation: We still don't know the best way to implement currently with pros and cons for broader and more restrictive use Counseling points included below but also need to discuss risk of AMR and side effects

And lest we not forget, doxycycline is effective against Staph aureus, and increased use can increase resistance to Staph aureus (subclinical resistance present)

As for Mycoplasma genitalium, 11% in Ipergay had Mgen, we know there are high rates of resistance to macrocodes and increasing to quinolone, with doxycycline being the alternative, something to definitely keep in the back of our minds and again need more data for all of these

Doxycycline is important for chalmydia, syphilis, and Mycoplasma genitalium, with resistance needing to be followed closely. Not much data on chlamydia and syphilis resistance, theoretical potential of syphilis resistance to doxy but still primary non-betalactam

What about antimicrobial resistance?? We know gonorrhea has developed resistance to everything we have thrown at it, with azithromycin serving as a cautionary tale

Now how will Doxy PEP affect the microbiome?? MSM who have receptive anal sex have enriched Prevotella microbiome, lube also affects microbiome. Not many studies on Doxycycline and its effect on microbiome

Gonococcal Tetracycline susceptibility - baseline 25% TCN resistance, but still saw results which is interesting. Still would resistance increase with more Doxy PEP use?? More research needed

Participants typically took 16 doses per month based on pill count, majority took <10 doses/month. No change in sex partners, condoles sex, or risk compensation.

Amazing results with Doxy PEP, 65% reduction in STIs per quarter, 55-57% reduction in GC, 74-88% reduction in CT, and 87% reduction in syphilis (only significant among PrEP but not much baseline syphilis)

We have opened up more slots for the Monkeypox vaccination at Mortimer Market Centre today. Take a look at our bookable appointments for eligible patients here: zesty.co.uk/practices/cnwl… @MMC_cnwl

#IUSTI2022 Whole-genome sequencing now main steam for gonorrhea #AMR in high-income settings see e.g @LancetMicrobe from USA bit.ly/3Rkj6zt 1/2

lack of cheap "true" PoC tests for STIs barrier to effective programming - Jeffrey Klausner presenting at IUSTI exciting preliminary result from @FIND for GC lat flow @DrJasonJOng @ccasejohn @mylittlebaklava

@mdoherty_hiv at IUSTI calling for research and development for STI vaccines & the launch of a new website STIwatch.org - a joint effort from @HIVpxresearch @NIAIDNews and @WHO

@DewsnapClaire "This outbreak of this clade/lineage has been overwhelmingly sexually transmitted" I think a better description. Same clade in other circumstances might not be. It's not all in the pathogen...