In a bold public health move, San Francisco saw a sharp decline in the rate of sexually transmitted infections (STIs) among at-risk communities following the implementation of guidelines for the antibiotic doxycycline post-exposure prophylaxis (doxy-PEP). According to data showcased at the Conference on Retroviruses and Opportunistic Infections in Denver, Colorado, reported cases of chlamydia and early syphilis dropped by more than half in just over a year among men who have sex with men (MSM) and transgender women.

Officials at the San Francisco Department of Public Health (SFDPH) were optimistic about the impact of doxy-PEP in curbing an STI epidemic that had been gaining ground in the city. Dr. Grant Colfax, Director of Health, emphasized the significance of this quick pivot from research to practice. "This effort is a tremendous example of the rapid translation of research into public health practice," he said, as reported by SFDPH. Despite these positive results, there was no noted decline in gonorrhea rates among the same groups.

San Francisco's initiative comes in the wake of a clinical trial that showed a two-third reduction in acquiring STIs like syphilis, gonorrhea, and chlamydia when doxy-PEP is taken after unprotected sex. SFDPH has tailored its guidelines towards those at higher risk, including individuals with a history of bacterial STIs and those engaging in condomless sex. Since the implementation, over 3,500 people in the city have been prescribed the medication.

As the first city in the nation to adopt doxy-PEP guidelines, San Francisco is setting a precedent in sexual health innovation. "San Francisco has long been a center of innovation, and our early implementation of doxy-PEP is an excellent example of public health experts, researchers, and community coming together and taking the lead in addressing our most critical health issues," Dr. Susan Philip, San Francisco Health Officer told SF.gov. The SFDPH urges anyone interested in doxy-PEP to consult their medical provider. Uninsured individuals or those experiencing difficulty accessing care can seek guidance from the San Francisco City Clinic.

The downward trend in STI numbers is promising, but public health officials remain cautious. They acknowledge that the pattern of STIs is influenced by a range of factors, including behavioral changes post-mpox outbreak and disruptions in STI testing due to the COVID-19 pandemic.