DoxyPEP gains ground globally, but policy gap limits access in PH

Sexually transmitted infections (STIs) continue to rise in the Philippines, with individuals aged 15–24 among the most affected. Data from the Department of Health (DOH) show a consistent increase in reported Human Immunodeficiency Virus (HIV) cases over the past few years.

Figure 1. Distribution of diagnosed HIV cases, by age group at diagnosis, 1984 -  April 2025

The country remains one of the fastest-growing HIV epidemic hotspots in the Asia-Pacific region, raising concerns from health experts and youth advocates. This suggests that STI transmission is highly influenced by stigma and misinformation.

Amid the rise in cases, a new prevention tool has gained attention. DoxyPEP, or doxycycline post-exposure prophylaxis, is an antibiotic taken within 72 hours after unprotected exposure to reduce the risk of bacterial STIs such as syphilis, chlamydia, and gonorrhea.

Major clinical trials in the United States, later cited by the Centers for Disease Control and Prevention (CDC), found that DoxyPEP reduced syphilis and chlamydia infections by more than 70% and gonorrhea infections by around 50% among high-risk groups.

However, health experts warn that widespread and unsupervised use may contribute to antimicrobial resistance. The CDC cautions that overuse of antibiotics can allow bacteria to develop resistance, potentially lessening treatment options in the future.

What is Doxycycline?

Doxycycline, a semi-synthetic tetracycline antibiotic, emerged from post–World War II research and later became a cornerstone treatment for bacterial infections.

Developed by Pfizer scientists in 1967, it improved upon earlier antibiotics by offering enhanced stability, improved absorption, and once-daily dosing.

Now widely available nationwide as a prescription-only medication, doxycycline is used to treat a range of bacterial infections, including respiratory tract infections, skin infections, urinary tract infections, and STIs.

In the context of sexual health, it remains a standard treatment in many clinics and hospitals for common STIs such as chlamydia and syphilis, in line with national health guidelines.

However, doxycycline is not limited to treatment. DoxyPEP has emerged as a preventive strategy in recent years.

In countries such as the United States and several European nations, health authorities now recommend doxycycline as an additional preventive measure against certain STIs, alongside conventional approaches like condom use and HIV pre-exposure prophylaxis (PrEP).

Emerging in private care

Despite evolving international recommendations, local implementation remains lacking.

While some private clinics have begun offering DoxyPEP for STI prevention, the DOH has yet to formally incorporate it into its national STI management guidelines.

This has created a gray area in practice, where clinical decisions are increasingly shaped by international references rather than unified local policy.

In private settings such as Hara Clinic, DoxyPEP is already being prescribed to patients following high-risk exposure. 

According to Dr. Jhovan Pascual, a general practitioner, the clinic routinely offers doxycycline within 72 hours after unprotected sexual encounters as a form of post-exposure prophylaxis.

He cited studies showing that the intervention provides around 86 to 87 percent protection against syphilis and chlamydia, though significantly lower protection against gonorrhea.

This reflects a growing reliance on international guidelines, particularly from the CDC, in the absence of localized direction.

“As long as physicians follow established guidelines, whether local or international, the practice remains justified,” Pascual said, noting that prescribing decisions are often guided by available scientific evidence rather than national policy gaps.

However, without formal DOH guidance, access to DoxyPEP remains largely confined to private healthcare settings.

Public health access gap

For individuals relying on public social hygiene clinics (SHCs) at the community level, the absence of national guidelines translates into limited access to emerging prevention tools.

Most public facilities remain bound by existing DOH protocols, which do not yet include DoxyPEP. As a result, services continue to focus on testing, treatment, and conventional prevention methods.

A PUP student who regularly avails himself of services from a community SHC said that while consultations are accessible, preventive options remain limited.

“Accessible naman ‘yong services, but limited siya to testing and treatment. Wala talagang discussion about newer prevention methods,” Paul (not his real name) said.

The lack of formal guidance also affects awareness. Without institutional support, awareness of newer interventions often relies on external sources.

“I only found out about DoxyPEP online. It wasn’t something that was explained or offered during consultations,” he added.

Without DOH endorsement, public health facilities are less likely to provide or even discuss the intervention, effectively restricting access to those who can afford private care. This creates a gap in access, where emerging prevention tools remain available only in certain settings despite growing awareness.

“It feels like may divide. If you can pay, you get more choices. If you rely on public clinics, you stick with what’s already standard,” Paul said.

Policy in review

The DOH continues to expand STI prevention campaigns nationwide, including free HIV testing, distribution of contraceptives, and seminars aimed at promoting safer sexual practices.

While biomedical tools like DoxyPEP are emerging internationally, the DOH has yet to integrate such interventions into official STI prevention guidelines in the country. The department emphasized that any new preventive measures must be carefully evaluated before adoption.

Access to services remains uneven across the country. Rural communities face limited healthcare facilities and fewer educational discussions, resulting in a stigma that often discourages individuals from getting tested. 

The DOH also warns against self-medication and unregulated use of antibiotics. Health professionals stress that STI treatment and prevention tools should always be guided by licensed medical practitioners.

In an exclusive interview, Dr. Marian Frances Ysaac, Medical Officer IV of DOH, explained that the primary public health concern regarding DoxyPEP is antimicrobial resistance (AMR). 

When patients take antibiotics without a prescription or fail to follow proper dosing instructions, the medication can be rendered ineffective against the bacteria it is meant to combat. 

“The implications kasi nito is that it could potentially lead to harder to treat infections and prolonged illnesses if we leave all of these unmonitored,” Dr. Ysaac warned. 

She further noted that the DOH is looking into the risk that individuals might use DoxyPEP as a substitute for comprehensive STI prevention and testing rather than as a supplementary part of a healthy approach to sexual health. 

Despite the absence of formal national guidelines, the DOH is actively monitoring the situation through the Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP). 

The program is a collaboration between the Epidemiology Bureau and the Research Institute for Tropical Medicine (RITM), through which they collect data on antibiotics that are beginning to exhibit high rates of resistance. 

The department is also in close coordination with the Food and Drug Administration (FDA) to address the "off-label" use, misuse, and adverse drug reactions through the VIGI Mobile application. This platform aims to strengthen the reporting of adverse drug reactions for medicines, vaccines, and other health products, serving as a vital surveillance tool.

As new health interventions like DoxyPEP gain traction, the DOH urged the media and the public to remain vigilant against misinformation. 

Dr. Ysaac emphasized that any information regarding emerging STI prevention should always be validated through legitimate health practitioners. 

Between practice and policy

The emergence of the so-called “morning-after pill for STIs” has sparked a discussion, weighing the individual benefits to patients against the broader legal and ethical aspects of public health. 

The legal landscape for DoxyPEP differs vastly across the Pacific. Compared to the United States, the CDC recently released formal clinical guidelines, providing a clear and legal medical framework for its use. This gave American doctors a “go signal” to prescribe the said antibiotic to high-risk groups. 

On the other hand, the Philippines has yet to have such a framework. According to DOH, they are following a “wait-and-see” approach. 

Currently, the department is using the World Health Organization (WHO) Consolidated Operational Handbook on STIs, and is withholding the endorsement of DoxyPEP until more local evidence is available. 

This leaves the country in a gray area, where the drug is available in several private clinics, but its preventive usage is not locally supported. 

“Currently, we don’t have nationally endorsed guidelines… but we do respect the sound clinical judgement of our attending physicians,” Dr. Ysaac noted. 

While not illegal, this clinical discretion comes with a cost. If a patient experiences a severe adverse reaction, the lack of an official protocol means the doctor handling the patient could face strict scrutiny on whether they met the local standard of care. 

To mitigate this, Dr. Ysaac emphasized the legal necessity of informed consent. Patients must be explicitly told about its uses and be fully briefed on the risks. 

As the country waits for the WHO to release more definitive recommendations, the DOH advises people to remain cautious. 

For now, STI prevention in the country still relies on traditional approaches such as condoms, while the legal status of DoxyPEP remains subject to clinical discretion.

What comes next?

DoxyPEP is gaining attention as a potential tool in STI prevention, supported by growing international evidence.

However, the country’s absence of national guidelines continues to shape how it is accessed and used.

While private clinics have begun to adopt the intervention, public health facilities remain limited by existing protocols, leaving access uneven.

Dr. Ysaac said that the WHO is expected to release formal guidelines on the use of DoxyPEP by the second quarter of this year, which could inform future policy directions in the Philippines.

As the country waits for the WHO to release more definitive recommendations, the DOH is expected to calibrate its local framework accordingly, though the process remains extensive. 

As discussions continue, the challenge lies not only in evaluating its effectiveness but also in determining how it can be integrated into a system where access does not depend on the ability to pay.

Article: Brylle Varela and Gian Nicole Chua

Graphics: Jan Mike Cabangin