Abstract Bacterial sexually transmitted infections (STIs) have been increasing over the past 2 decades in gay, bisexual, and other men who have sex with men. With the widespread use of early human immunodeficiency virus (HIV) treatment, which virtually eliminates transmission risk, and the availability of HIV pre-exposure prophylaxis, there have been attitudinal changes regarding HIV infection with resultant increases in sexual contact and declines in condom use. Doxycycline is used for primary prophylaxis in a number of infectious diseases. We conducted a state-of-the-art review to examine the current state of research, knowledge gaps, and challenges around the use of doxycycline prophylaxis to prevent syphilis and other STIs. International academic and government experts met in March 2019 to frame the initial inquiry, which was supplemented by focused literature searches. Two small short-term randomized controlled trials examining doxycycline prophylaxis found high efficacy. Five additional clinical studies are underway or in development. Studies differed in design, population, outcomes, and safety measures. Doxycycline prophylaxis for bacterial STIs shows promise. Better and more robust data are needed on efficacy; target population; community acceptability; behavioral risk compensation; doxycycline dose, regimen, and formulation; long-term safety; antimicrobial resistance; cost-effectiveness; and risk–benefit.

Biomedical prevention for human immunodeficiency virus (HIV) in the United StatesSince the Food and Drug Administration's (FDA) approval of Truvada (emtricitabine/tenofovir disoproxil fumarate) for the use of pre-exposure prophylaxis (PrEP) in 2012, the annual rate of HIV diagnosis in the United States has been decreasing, from 13.2 per 100,000 population per year in 2012 to 11.8 in 2017 (1). However, the annual number of diagnoses remains high with 38,739 new cases in 2017 (1). Socioeconomic disparities in HIV continue to persist, with the highest infection burden being placed upon young men who have sex with men (MSM) of color (2). This pattern of socioeconomic disparities is also reflected in PrEP uptake, which remains low amongst those who are most at risk for HIV. PrEP users are more likely to be white (3,4), between the age of 35-44 years old (5,6) and have private insurance rather than Medicaid or to be uninsured (6). Although PrEP use among MSM in the United States has increased from 5.7% in 2014 to 35% in 2017, uptake in the black and Hispanic/Latino MSM communities lags behind (7). In other words, PrEP is not reaching those who need it the most-our young MSM of color.Many structural factors contribute to the disparities in PrEP uptake in the United States. Documented barriers to PrEP use and adherence include stigma, financial cost, healthcare system inaccessibility, fear for side effects, competing stressors, and low HIV risk perception (2,(8)(9)(10)(11). For individuals who are aware of their own HIV risk and the efficacy of PrEP, fear of homophobia from healthcare providers and potential outness to friends and family remains one of the main roadblocks that prevent patients from seeking care. Following along the PrEP care continuum, amongst those with high acceptability

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The SD BIOLINE HIV/Syphilis Duo (SD BIOLINE DUO) rapid test is a dual rapid lateral flow immunoassay that detects antibodies to both human immunodeficiency virus (HIV) and Treponema pallidum (TP) ‘syphilis’ via fingerprick whole blood. We evaluated the field performance of the SD BIOLINE HIV/Syphilis Duo test among two populations in Hanoi, Vietnam – men who have sex with men (MSM) and pregnant women. We also surveyed factors that influence participants’ willingness to test for HIV and syphilis. This test has the potential to increase HIV and syphilis screening in low-resource settings. Patients who received healthcare services at a sexual health clinic for MSM and a district antenatal care center in Hanoi, Vietnam were recruited for the study. Participants with HIV and syphilis were intentionally recruited for adequate test performance evaluation via convenience sampling. At each facility, venipuncture blood specimens were obtained for reference testing for HIV and TP using SD BIOLINE HIV 1/2 3.0 and TP particle agglutination, respectively. SD BIOLINE DUO was compared to the standard reference tests and sensitivity and specificity were calculated. We calculated 95% confidence interval (CI) using the exact binomial method. We used conjoint analysis to identify test attributes that are associated with participant likelihood to seek HIV and syphilis testing. Of 280 participants, 100 (35.7%) were MSM and 180 (64.3%) were pregnant women. Of MSM, 17 (17.0%) were HIV positive and 49 (49.0%) were TP seropositive. All women were negative for both HIV and syphilis antibodies. For HIV antibody testing, sensitivity and specificity were 100.0% (95% CI: 80.5–100.0%) and 100.0% (95% CI: 98.6–100.0%), respectively. For the syphilis antibody testing, sensitivity and specificity were 83.1% (95% CI: 71.0–91.6%) and 100.0% (95% CI: 98.3–100.0%), respectively. Potential for false positives, preference for one blood draw over two, and shorter wait time for testing results were the highest ranked attributes by participants according to their willingness to test. The SD BIOLINE HIV/Syphilis Duo rapid test demonstrated very good performance in this field setting and participants preferred attributes that aligned well with this test.

Background: Prophylactic administration of doxycycline is regarded as a potential new public health strategy to combat the rising rates of Chlamydia trachomatis infections and syphilis among men who have sex with men. We conducted a survey-based study to evaluate how community members and health care providers in Southern California would perceive doxycycline preexposure/postexposure prophylaxis (PrEP/PEP) to predict its acceptability and identify potential areas of concern. Methods:We conducted an online cross-sectional survey among community members who identify as men who have sex with men and health care providers with prescribing authority in Southern California to investigate the current attitudes toward doxycycline PrEP/PEP, including their willingness to accept. We analyzed the data using descriptive statistics and binary logistic regression.Results: Among 212 enrolled community member participants, 67.5% indicated they would take doxycycline PrEP/PEP if offered by their provider. Higher acceptability was significantly associated with several characteristics, including recent history of bacterial sexually transmitted infection diagnosis and current use of HIV PrEP. For health care providers, 89.5% of 76 enrolled participants expressed willingness to prescribe doxycycline PrEP/PEP to their patients if recommended by the Centers for Disease Control and Prevention, but only 43.4% were willing if not. Both community members and health care providers demonstrated high levels of concern toward possible drug resistance.

Curable sexually transmitted infections in pregnant women may cause poor maternal and newborn outcomes worldwide. Syndromic management is practiced in many settings yet fails to identify most infections. Etiologic screening has promise, but further effectiveness and cost-effectiveness studies are needed. Supplemental digital content is available in the text.

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