DoxyPEP consult by phone with a Specialist GP, anywhere in Australia. Doxycycline taken after condomless sex to lower the risk of bacterial STIs — the GP assesses suitability on the call and arranges it.
Current Australian guidance applied. Same-day phone consults usually available, 7 days a week.
Pathology tests covered by Medicare and most Private Health Insurers.
DoxyPEP
DoxyPEP is for higher-risk users, not the general population. Current Australian guidance supports it for men who have sex with men and trans women who have had a bacterial STI in the past 12 months, are having frequent condomless sex with multiple partners, or are engaged in chemsex. It is not routinely recommended for cisgender women, pregnancy, or people with low ongoing risk.
Quarterly STI screening is essential, not optional, while on DoxyPEP. Australian STI Management Guidelines recommend a 3-monthly comprehensive screen — chlamydia, gonorrhoea, syphilis, HIV, hepatitis B, plus throat and anal swabs — both to catch breakthrough infections and to monitor for antimicrobial resistance.
What DoxyPEP is. DoxyPEP is a single oral dose of doxycycline taken within 72 hours of condomless sex to reduce the risk of bacterial STIs — particularly chlamydia and syphilis. It is event-driven, not daily and not pre-emptive: taken only after a possible exposure, and the sooner the better. The Specialist GP works through the right approach for your situation on the call and advises a safe weekly maximum.
The evidence. The pivotal randomised trial in MSM and trans women on PrEP or living with HIV showed an 88 percent reduction in chlamydia, 87 percent reduction in syphilis, and a 55 percent reduction in gonorrhoea, compared with standard care. Two French trials supported the chlamydia and syphilis findings. A cisgender-women trial in Kenya did not show benefit, which is why current Australian guidance does not routinely recommend DoxyPEP for cisgender heterosexual women. Australian uptake accelerated after national guidance was published in 2024.
Who it is for, and who it is not. Australian guidance supports DoxyPEP for MSM and trans women with one or more of: a bacterial STI in the past 12 months, frequent condomless sex with multiple partners, or chemsex with associated condomless sex. It is not routinely recommended for cisgender heterosexual women, anyone pregnant or breastfeeding, severe tetracycline-class allergy, significant liver impairment, or people without ongoing risk — for example, monogamous partnerships with a recent negative screen. For some people, consistent condom use, regular screening, or PrEP alone is the better fit.
How to take it. A single oral dose within 72 hours of condomless sex, sooner the better. Take with a full glass of water and food to reduce nausea, and stay upright for 30 minutes — doxycycline can irritate the oesophagus if you lie down. Avoid dairy, calcium, iron, and zinc supplements within 2 hours, as they reduce absorption. A weekly cap applies; if you have multiple exposures in one week, the Specialist GP works through the implications with you. Mention any other treatment you take on the consult — particularly warfarin, oral retinoids, or severe drug allergy.
Antibiotic resistance is the biggest concern. Widespread DoxyPEP use raises legitimate AMR concerns. Australian surveillance has shown rising doxycycline resistance in gonorrhoea over the past decade, which is part of why DoxyPEP's gonorrhoea effect is smaller than its chlamydia and syphilis effect. There are also theoretical concerns about resistance in skin bacteria, respiratory germs, and gut commensals. The trade-off is real, and the consult includes an explicit discussion: current guidance favours DoxyPEP in higher-risk groups, where the individual-level prevention benefit outweighs the population-level AMR risk, but not in low-risk populations.
DoxyPEP and PrEP work together. Many users take both PrEP and DoxyPEP — PrEP prevents HIV, DoxyPEP reduces bacterial STIs. The quarterly screening cadence works for both, so the Specialist GP coordinates them at the same consult. For 72-hour post-exposure HIV prevention separately, see emergency PEP.
Side effects. Single-dose event-driven DoxyPEP is generally well tolerated, and total annual exposure is much lower than continuous daily doxycycline. The common issues are gastrointestinal upset (nausea, diarrhoea), photosensitivity — a real issue under the Australian sun, so use sunscreen — and oesophageal irritation if taken without water or while lying down. Less commonly, thrush from microbiome disruption.
Cost. With Medicare, the Specialist GP consult is bulk-billed and pathology tests are covered by Medicare — STI testing is free. Without Medicare, the consult is $59 and additional lab fees may apply — most Private Health Insurers cover the lab tests; check with the lab you attend. If you test positive, the treatment consult is bulk-billed for Medicare card holders or $59 without.
Frequently asked questions
The pivotal DoxyPEP RCT (Luetkemeyer et al, NEJM 2023) was conducted in MSM and trans women on PrEP or living with HIV in San Francisco and Seattle. It showed an 88% reduction in chlamydia, 87% reduction in syphilis, and 55% reduction in gonorrhoea acquisition compared to standard care. The earlier French IPERGAY substudy (2017) supported the syphilis and chlamydia signal. The cis-women dHARP study in Kenya (2023) was disappointing. Australian guidance was updated in 2024 to support DoxyPEP for MSM and trans women. See Evidence base.
Doxycycline resistance is widespread in Neisseria gonorrhoeae globally and the AGSP (Australian Gonococcal Surveillance Programme) has documented significant Australian increases over the past decade. The lower gonorrhoea effectiveness reflects this background resistance. Effectiveness against chlamydia and syphilis is much more reliable. Quarterly STI screening on DoxyPEP is essential to catch breakthrough gonorrhoea infections. See Antibiotic resistance.
Yes — current Australian guidance supports combined use. PrEP prevents HIV; DoxyPEP reduces bacterial STIs. Many MSM patients use both simultaneously. Quarterly PrEP monitoring covers the screening cadence needed for both. Some patients use 2-1-1 on-demand PrEP and on-demand DoxyPEP together for episodic higher-risk encounters. The Specialist GP coordinates both at the same consult.
A real concern. Widespread DoxyPEP use may increase doxycycline-resistant Neisseria gonorrhoeae, Staphylococcus aureus (including MRSA), and gut commensals. The AGSP monitors gonorrhoea resistance trends nationally. Current Australian guidance balances individual prevention benefit against population AMR risk — the balance favours DoxyPEP in higher-risk groups but not in low-risk populations. The consult includes an explicit discussion of this trade-off. See Antibiotic resistance.
No — current Australian guidance does NOT routinely recommend DoxyPEP for cisgender heterosexual women. The dHARP study in Kenyan cis women did not show significant STI reduction, though sample size and adherence factors may have contributed. For cis women with high bacterial STI risk, alternatives include consistent condom use, regular partner STI screening, and quarterly comprehensive STI testing rather than DoxyPEP.
Yes — absolutely essential. Australian STI Management Guidelines recommend 3-monthly comprehensive STI screening (chlamydia, gonorrhoea, syphilis, HIV, hepatitis B, plus extragenital throat and rectal swabs for MSM) for anyone using DoxyPEP. Breakthrough infections occur and need standard treatment. Many DoxyPEP users combine quarterly STI screening with the same consult that handles their DoxyPEP review. See Quarterly screening.
A single 200 mg oral dose taken within 72 hours of condomless sex (sooner is better). Take with a full glass of water and food (reduces nausea), upright (do not lie down for 30 minutes — DoxyPEP can cause oesophageal irritation), and avoid dairy, calcium, iron, and zinc supplements within 2 hours (these reduce absorption). Maximum dosing per current guidance is 200 mg per 24 hours and 600 mg per week. See How to take it.
Single-dose DoxyPEP is generally well-tolerated. Common: gastrointestinal upset (nausea, diarrhoea), photosensitivity (a real issue under the Australian sun — use sunscreen, particularly important for outdoor workers and beachgoers), oesophageal irritation if taken without water or while supine. Less common: vaginal or oral thrush, liver effects in pre-existing liver disease. Cannot be used in: pregnancy from the second trimester, severe tetracycline-class allergy. See Side effects.
Same-day. Phone consults are typically available within an hour or two of booking during business hours. The Specialist GP works through whether DoxyPEP fits your situation, discusses the AMR trade-off, and arranges treatment on the call. From booking to first dose is usually same-day or next-day.
Pathology tests are covered by Medicare and most Private Health Insurers. The Specialist GP phone consult (free with Medicare, $59 without) covers the Specialist GP visit. The booking system shows the out-of-pocket cost (if any) before you confirm. See Cost.
