[Question #12271] Should a man take doxypep after unprotected oral sex from a female sex worker?

9 months ago

Situation: A man receives unprotected oral sex from a female sex worker. He could get proscribed doxypep and take it within 24 hours of the sexual encounter. Would it be wise to get that prescription and take it, to reduce the risk of gonorrhea/clymydia? If it is taken, when can he get tested for gonorrhea?

This forum is a tremendous resource and I thank you for your help.

Edward W. Hook M.D.

9 months ago

Welcome to the Forum. Thanks for your questions. Doxy PEP is recommended for persons at high risk for infection, i.e. those with multiple partners who may be at risk. It is not recommended for most persons in your situation following a single exposure for the following reasons:

1. Most CSWs do not have STIs

2. Most single exposures do not result in infection. Transmission rates for receipt of oral sex are lower than transmission rates for genital exposures to infected partners

3. Receipt of unprotected oral sex is most strongly associated with acquistion of gonorrhea which is the STI that doxy-PEP works least well for. DoxyPEP is excellent (i.e. close to complete) protection against syphilis and chlamydia but provides 60% or less protection against gonorrhea. Taking doxy PEP will only confuse things if you wish to test gong forward.

4. Testing is easy and accurate any time more than 3-4 days following an exposure with a simple urine test.

In our clinic, we would not provide you with doxy-PEP following the exposure you describe.

I hope this perspective helps. EWH

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9 months ago

This is helpful info and it sounds like a man should not take it in this circumstance. If he were to take it, how long would he have to wait to test (I presume the treatment complicates testing)?

Edward W. Hook M.D.

9 months ago

As I said, I would not recommend it for you. Urine testing will provide conclusive results any time more than 3-4 days after the encounter. EWH---