[Question #13245] DoxyPep Efficacy & Testing window
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1 months ago
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Hello Doctor,
This is a follow up to question #13231.
It was mentioned it was an incredibly low risk for essentially all STIs, and that testing is not required, but could be completed for peace of mind.
My anxiety got the better of me and I made a drop in appointment at my local sexual health clinic. The purpose of the visit was to ask some questions, but they ended up testing me for gonorrhea, chlamydia, HIV, and syphilis. They run a panel on all patients, regardless of what the purpose of their visit is.
Nonetheless, I started speaking with the nurse about the encounter. She also claimed it was low risk, and recommended seeing a mental health professional (I have an appointment in approximately 3 weeks). In the interim, she offered a dose of doxy pep, as I was in a lot of mental distress. I took the dose of doxy pep when I got home with some water and food, about 60 hours after the encounter. Unfortunately, the small amount of food I had included an English muffin with some milk in it.
I am wondering the following:
How effective is doxy pep at preventing STIs if taken 60 hours later, rather than within 24 hours, and does the small amount of milk I consumed affect the drug absorption in any significant way? I'm specifically wondering about it's effectiveness in preventing syphilis, but wouldn't mind some information on it's effectiveness for gonorrhea and chlamydia.
At the STI clinic, they claim that gonorrhea and chlamydia tests are conclusive at 48 hours, and syphilis is conclusive at 3-6 weeks. Can you provide any information regarding the discrepancy between my internet research, the claims made by your team of experts on this forum, and what the clinic is stating regarding testing windows?
This is a follow up to question #13231.
It was mentioned it was an incredibly low risk for essentially all STIs, and that testing is not required, but could be completed for peace of mind.
My anxiety got the better of me and I made a drop in appointment at my local sexual health clinic. The purpose of the visit was to ask some questions, but they ended up testing me for gonorrhea, chlamydia, HIV, and syphilis. They run a panel on all patients, regardless of what the purpose of their visit is.
Nonetheless, I started speaking with the nurse about the encounter. She also claimed it was low risk, and recommended seeing a mental health professional (I have an appointment in approximately 3 weeks). In the interim, she offered a dose of doxy pep, as I was in a lot of mental distress. I took the dose of doxy pep when I got home with some water and food, about 60 hours after the encounter. Unfortunately, the small amount of food I had included an English muffin with some milk in it.
I am wondering the following:
How effective is doxy pep at preventing STIs if taken 60 hours later, rather than within 24 hours, and does the small amount of milk I consumed affect the drug absorption in any significant way? I'm specifically wondering about it's effectiveness in preventing syphilis, but wouldn't mind some information on it's effectiveness for gonorrhea and chlamydia.
At the STI clinic, they claim that gonorrhea and chlamydia tests are conclusive at 48 hours, and syphilis is conclusive at 3-6 weeks. Can you provide any information regarding the discrepancy between my internet research, the claims made by your team of experts on this forum, and what the clinic is stating regarding testing windows?
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Edward W. Hook M.D.
1 months ago
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Welcome back. I'm sorry you continue to worry.
As you know, taking doxypep is recommended within 24 hours of an encounter. There ar few data on efficacy when taken later. I suspect that the doxypep however would be quite effective for syphilis prevention at 60 hours. As for gonorrhea and chlamydia, DoxyPep while close to completely effective for chlamydia prevention and is only about 60% effective for gonorrhea prevention when taken as designed and the effectiveness of later dosing for either gonorrhea or chlamydia is probably somewhat lower but how much is unknown.
I cannot comment on the discrepancy. the figures you were given seem a bit early. EWH
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1 months ago
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Thank you doctor.
When you say doxy pep is close to completely effective, can you expand on that? Based on what I can see, it reduces syphilis and chlamydia risks by 80-90%, but what does that reduction mean/look like in my case?
Are you able to answer if the small amount of dairy I had will impact the drugs efficacy?
Regarding the timing, my apologies but there seems to be a grammatical error. I'm assuming you meant to state there have been few studies on doxy pep beyond 24 hours?
Does taking doxy pep at 60 hours significantly (significant being the keyword) impact it's efficacy, or are we looking at a fraction of a percent drop? If I am understanding you correctly, there isn't any data, so where does the 72 hour window come from, and what's your personal experience with the drop in efficacy, if you are able to quantify(?) that experience. If it's less effective, why is there a 72 hour window cut off and not 24 hours?
Finally, I just wanted some clarification on my previous question. My apologies, as English is not my first language and I'm having a hard time understanding. In the original reply you stated you'd recommend testing for gonorrhea and syphilis based on giving oral sex (throat swab). I did not give oral sex, only received (his mouth on my penis). In a later reply, you state since I did not give oral sex, you do not feel strongly that I need STI testing, unless symptoms appear. To clarify, since I did not give oral sex, only received, am I interpreting your second response to mean that no testing (not even gonorrhea or chlamydia) is recommended or medically necessary, but I can choose to test for peace of mind (i.e. if I came to your clinic, you would not recommend any STI testing based on my exposure, is that correct?), and your recommendation would be to proceed with unprotected sex with my regular partner with no worry?
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Edward W. Hook M.D.
1 months ago
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A 90% reduction of the already very small risk makes your risk far less than 1%
A small amount of milk will have no meaningful effect.
As I said there are few data on DoxyPep taken later than was studied but I would suspect the effect on chlamydia and gonorrhea prevention would be a substantial drop in efficacy. The 72 hour figure is based on microbiology- the longer the delay the longer rapidly growing organisms like gonorrhea and chlamydia have to establish themselves ( prevention takes less medication than treating established infection)
As I said before I don’t feel strongly that you need testing, particularly now that you’ve taken DoxyPep and would not avoid sex with my regular partner.
One follow up remaining. Please don’t waste it on what if questions. They serve no purpose. EWH
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1 months ago
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That makes total sense regarding biology and doxy pep timing. Thank you for the clarification. To clarify, so I'm understanding correctly, doxy pep would essentially drop my syphilis risk between 0%-1%, with the chance being closer to 0%, is that correct? Syphilis is my primary concern at the moment, since it can present without symptoms and takes a long time to show on tests.
Would taking doxy pep delay the window in which gonorrhea is detected? As you've mentioned many times, it appears chlamydia is not an issue as it is never passed orally, so fortunately I am not concerned there.
I'm assuming since I have no symptoms and several days have passed, would it be safe to assume I did not catch gonorrhea?
Is there any concern regarding NGU/NSU? Regardless if yes or no, can you expand?
Are there any other STIs I may be at risk for or need to watch out for? Apologies if I have asked this already.
Thank you for confirming you do not believe it is medically necessary to test for any STIs and I can resume unprotected oral and vaginal sex with my regular female partner.
One last confirmation, and apologies if it's repetitive. To summarize, it was an extremely low risk exposure, doxy pep made it even lower (even taken at 60 hours) No testing is medically necessary (unless symptoms appear) and you would not recommend testing based on this exposure, and I can safely put this behind me and return to my life without worry, yes?
Fyi, I have another test scheduled on Saturday for gonorrhea and syphilis. I can let you know the result for other users' to see when they review this thread.
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Edward W. Hook M.D.
1 months ago
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These are repetitive despite my request no to waste your time. These are final answers. Please do not return. If you do, repetitive questions may be deleted without a response or return of your posting fee.
Closer to 1%.
Theoretically DoxyPep could slightly delay gonorrhea detection. I would suggest waiting for at least five days after DoxyPep before testing if you choose to test.
About 10% of gonorrhea is asymptomatic and detected only by testing.
I would not worry about NGU. DoxyPep makes it even less likely.Don’t go down that rabbit hole.
Move on stop worrying.
Your summary is correct. I will leave the thread open ONLY so you can post your test results. If you ask further questions the thread will be closed. EWH
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1 months ago
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Hi Doctor,
The tests for gonorrhea and chlamydia came back negative about 8 days post-encounter and 6 days post doxy-pep. I'm assuming these results can be taken as conclusive.
Thanks again
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Edward W. Hook M.D.
1 months ago
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Final comment. These results are conclusive. I urge you to believe them and do your best to move forward.
Closing the thread now. EWH
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