Everything you need to know about Doxypep in The Netherlands

What is Doxypep and does it really work against STIs? Read here how the antibiotic works, the risks, and why it is not yet widely prescribed in the Netherlands.

The drug (largely outside the regular prescription process in the Netherlands) is increasingly discussed among men who have sex with men, and is gaining prominence in conversations about sexual health care. Is Doxypep the miracle drug we were waiting for? Or rather a potential danger to public health — resistance, disruption of your gut flora, and questions about who should or should not use it at all. In this article, we delve into what Doxypep is, how it works, what the risks are, and what is relevant for you in the queer/LGBTQIA+ community.

What exactly is Doxypep?

Doxypep is a contraction of the terms “doxycycline” (an antibiotic) and “post-exposure prophylaxis” (prophylaxis = prevention after exposure). Specifically: someone takes two pills of doxycycline within about 72 hours (preferably earlier) after a possible risk moment (e.g., unprotected sexual contact) to try to prevent an STI such as chlamydia, gonorrhea, or syphilis.

Does Doxypep work?

Yes, but with many caveats. According to experts:

• For chlamydia: there are indications that DoxyPEP can have an effect.

• For gonorrhea: often not effective in the Netherlands, because gonorrhea is often already resistant to antibiotics like doxycycline.

• For syphilis: there may be a preventive effect (70-80%) according to some studies. But syphilis is relatively less common in the Netherlands, so the 'return on antibiotic' is limited.

Is Doxypep legal and recommended in the Netherlands?

Not really. In the Netherlands, Doxypep is not yet routinely prescribed for this use. General practitioners are cautious about prescribing antibiotics when they are not strictly necessary. Moreover, the drug is not regularly approved or established in the context of 'taking after sexual contact as prevention.'

What are the risks or disadvantages of Doxypep?

• Antibiotic resistance: frequent or preventive use can increase the risk of resistance — not only for yourself but for the broader population/healthcare.

• Disruption of gut flora/healthy bacteria: even one-time use can already affect your gut bacteria.

• False sense of security: those who use Doxypep may think they are 'safe,' while infections can still occur or resistance may already be present. For example, gonorrhea where the drug does not work.

• Test results can be affected: using Doxypep can, for example, cause a syphilis test to come back negative even though there has been an infection.

Who is Doxypep relevant for?

Relevant: people at relatively high risk (e.g., multiple partners, unprotected sex, part of sexual networks) may consider it. Not or less relevant: people at low risk, or where other preventive measures (such as regular testing, condoms, vaccinations) work well — then the use of preventive antibiotics may be undesirable. Note: in the Netherlands, there is no broad guideline recommending Doxypep for everyone.

What are the alternatives to Doxypep?

• Regular STI tests: keep testing, even if you use Doxypep. It is not a free pass to relax.

• Education & behavioral measures: condom use, talking with partners, knowing your risk.

• Vaccinations: for some infections like Mpox, hepatitis A, and hepatitis B, you can get vaccinated.

• Good medical guidance: talking to your doctor or STI clinic about your specific situation is crucial.

What is the final advice?

Doxypep is not the magic pill that solves all STIs — but it can be a consideration under specific circumstances. It's important to weigh and consider: your own risk, your health, the broader public health implications. And above all: stay critical. If you decide to use it anyway, mention it during your STI test and ensure you use reliable medication (not something of dubious origin).