Rising Unsupervised Use of Antibiotics to Prevent STIs in the Netherlands

Recent research highlights a concerning increase in the informal use of antibiotics, specifically doxycycline, as a preventive measure against sexually transmitted infections (STIs) among key populations in the Netherlands. An online survey involving 1,633 respondents—mainly men who have sex with men (MSM), transgender, and gender-diverse individuals—found that 15% had used doxycycline for either post- or pre-exposure prophylaxis (doxyPEP/PrEP) in the recent past, with a significant 65% intending to use it in the future. Surprisingly, a large portion of this use was without medical supervision, as doxyPEP/PrEP is neither officially recommended nor promoted by healthcare providers in the country.

The study, published in Eurosurveillance, suggests that informal, non-prescribed use of doxycycline could contribute to antimicrobial resistance (AMR) and potentially alter the microbiome, raising public health concerns. Despite this, doxyPEP has shown promise in reducing the incidence of bacterial STIs like syphilis and chlamydia in clinical trials, and there's evidence it might help prevent other bacterial infections such as gonorrhea.

Participants in the survey primarily obtained doxycycline from abroad or through prescriptions, paying an average of €30. Factors associated with increased use included being on HIV PrEP, living with HIV, and engaging in chemsex or group sex. The high willingness to purchase doxyPEP if it becomes available legally underscores a real demand for STI prevention methods within these communities.

However, experts warn that widespread, unsupervised prophylactic antibiotic use could accelerate the development of antibiotic resistance and complicate public health efforts. Monitoring and stewardship are crucial to balance the benefits of STI prevention with the risks of antimicrobial resistance. Future guidelines should incorporate surveillance of resistance patterns to mitigate long-term adverse effects.

Overall, the rise in informal doxycycline use underscores the need for public health initiatives to address misconceptions, promote responsible use, and establish monitoring frameworks to prevent exacerbating antimicrobial resistance issues.

For more information, refer to the original research in Eurosurveillance: [DOI: 10.2807/1560-7917.ES.2025.30.26.2400707]