Sen. Marco Rubio (R-FL) is questioning the Centers for Disease Control and Prevention over recent guidance for the prophylactic use of an antibiotic to prevent sexually transmitted infections, or STIs, raising the fear that the practice could have significant unintended consequences.
Rubio wrote to CDC Director Mandy Cohen this week asking about the agency’s preliminary recommendations for biological males who engage in same-sex intercourse to take the antibiotic doxycycline as a preventive measure against bacterial STIs. He said he is concerned that the recommendation will contribute to the problem of antimicrobial resistance, or AMR, when pathogens no longer respond to chemical medications to prevent and treat infectious diseases.
“AMR is a serious public health threat that kills thousands of Americans every year,” Rubio said. “I am concerned that this proposal is motivated more by politics than scientific rigor or long-term effects to patient health.”
The CDC guideline for doxycycline for STIs, also known as Doxy-PEP, is 200 milligrams taken within 72 hours of any form of sexual activity for biological men who engage in same-sex intercourse either with a history of at least one bacterial STI in the last year or deemed to be at “at ongoing risk for acquisition of bacterial STIs.”
Rubio raised the concern, however, that there is limited evidence on how this novel treatment approach could contribute to the problem of AMR, which could reduce the effectiveness of doxycycline across the population.
“Despite public health officials’ longstanding concern about the danger of AMR and overprescribing of antibiotics, the CDC appears now to be throwing caution to the wind,” Rubio said, noting that the CDC’s draft guidance is already influencing government policy at the state and local level.
A spokesperson for Rubio told the Washington Examiner that “the goal is to ensure that one of our nation’s primary health agencies is making decisions based on science and not politics.”
Republican senators have previously accused the CDC of letting politics influence medical practice, such as when the agency released guidance on so-called chestfeeding in July.
“It is important for public health officials to combat STIs with innovative methods, but it
is similarly critical that the CDC makes decisions based on science, not demands from activists
that downplay the risks of novel treatments,” Rubio wrote to Cohen.
Johns Hopkins University assistant professor of medicine Matthew Hamill told the Washington Examiner that, although physicians should always be concerned about AMR, the CDC’s decision to keep the preliminary recommendations solely to men who have sex with men may mitigate the risk.
“I’m always concerned about antibiotic resistance or antimicrobial resistance,” Hamill said, “[but] I think you already have a relatively restricted population where Doxy-PEP can be used, and even within that population is only going to be people who have recently had an STI or are at risk of acquiring an STI.”
Hamill, who specializes in the treatment and prevention of HIV and other STIs, noted that millions of people use doxycycline for a multitude of medical problems, including malaria, Lyme disease, and severe acne.
“My hunch is that the doxycycline use as Doxy-PEP is tiny,” Hamill said.
Hamill also noted that Doxy-PEP is not currently approved by the Food and Drug Administration for STI prophylaxis, likely in part due to concerns over AMR.
Bacterial STIs, including gonorrhea, syphilis, and chlamydia, are on the rise in the U.S., reaching records not seen since the 1950s before the widespread use of penicillin and other antibiotics.
Despite the growing rates of women in the U.S. contracting syphilis, the data on Doxy-PEP do not fully support its efficacy for biological women. There are additional concerns about prescribing doxycycline for women who may be or become pregnant, as the potent antibiotic may interfere with fetal bone development.
Rubio argued, however, that the antimicrobial-resistant bacteria can spread through a variety of ways including “proximity and poor hygiene” and therefore “the risk is not confined to one subset of the population and could ultimately affect the broader public.”
The CDC estimates that more than 35,000 Americans died in 2019 due to antimicrobial-resistant infections.
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Hamill said that AMR in the field of bacterial STIs is a growing problem, particularly drug-resistant strains of gonorrhea.
“I think we have to just be very mindful of [AMR] and pay really close attention in the future … keep doing surveillance so that we understand what’s happening with the microbiome in people who are using Doxy-PEP,” Hamill said.
