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Doxy-PEP and antimicrobial resistance in S. aureus, N. gonorrhoeae, and commensal Neisseria
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CROI 2023 Feb 2023
Annie Luetkemeyer, Deborah Donnell, Julie Dombrowski, Stephanie Cohen, Cole Grabow, Clare Brown, Cheryl Malinski, Sharon Martens, Alison Cohee, Veronica Viar, Phong Pham, Susan Buchbinder, Diane Havlir, Connie Celum, Olusegun Soge, on behalf of the DoxyPEP team
abstract
Background: Doxycycline post-exposure prophylaxis (doxy-PEP) is highly effective in reducing N. gonorrhoeae (GC), C. trachomatis (CT), and syphilis among men who have sex with men (MSM) and transgender women (TGW). Understanding the effect of doxy-PEP use on antimicrobial resistance (AMR) in N.gonorrhoeae and bacteria which can cause disease (S.aureus) or transmit resistance (Neisseria spp) is unknown.
Methods: DoxyPEP is a randomized open-label trial among MSM/TGW living with HIV or on PrEP with GC, CT, or early syphilis in the past year; participants were randomized 2:1 to 200 mg doxycycline within 72 hours of condomless sex or no doxycycline (SOC). At months 0 (M0) and 12 (M12), nasal/oropharyngeal swabs were cultured for S. aureus (SA) with doxycycline resistance (doxy-R) defined as MIC ≥16 μg/ml by E-test and oropharyngeal swabs cultured for commensal Neisseria (doxy-R: MIC ≥2 μg/ml by E-test). Participants with a positive GC test were instructed to return for swabs for GC culture through
the CDC SURRG program (TCN-R: MIC≥2.0 μg/ml by agar dilution). Overall proportion with growth or AMR at M12 were compared by Fisher's exact test.
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