Doxycycline postexposure prophylaxis: a cross-sectional survey on knowledge, attitudes and prescribing practices among Italian dermatologists of sexually transmitted infection centers

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BACKGROUND: Postexposure prophylaxis with doxycycline (Doxy-PEP) significantly reduces incidence of certain bacterial STIs in men who have sex with men (MSM) and individuals with recurrent STIs. We assessed knowledge, attitudes, and clinical experience regarding Doxy-PEP of dermatologists specialized in STI prevention, diagnosis, and treatment in Italy. METHODS: A cross-sectional survey was conducted in March 2025 using a questionnaire to investigate knowledge of Doxy-PEP prescribing protocols and patient eligibility, perceptions of its efficacy against several STIs, personal experience in Doxy-PEP prescription and drawbacks, opinions on its future use. RESULTS: Thirty-six dermatologists participated. All knew about Doxy-PEP. The population most frequently considered eligible for Doxy-PEP was represented by MSM (69.4%). Respondents would prescribe Doxy-PEP after recent exposure (<72 hours) to chlamydia (58.3%), syphilis (50.0%), gonorrhea (25.0%), or multiple partnership (55.6%). Chemsex was indicated as the main risky behavior worth prescribing Doxy-PEP (69.4%). Approximately half of the respondents considered Doxy-PEP effective against chlamydia (47.2%), whereas only 14.3% and 2.8% were convinced of its efficacy against syphilis and gonorrhea, respectively. Only 19.4% of the respondents had prescribed Doxy-PEP, with no adverse events reported. Doxy-PEP failure was observed by 36.1% of the dermatologists. The main concerns included Neisseria gonorrhoeae resistance (91.7%), methicillin-resistant Staphylococcus aureus (MRSA) selection (91.7%), and microbiota alterations (86.1%). A progressive increase in Doxy-PEP use is anticipated, driven by patient demand, community influences, and international guidelines. CONCLUSIONS: Dermatologists of Italian STI centers demonstrate appropriate awareness of Doxy-PEP but maintain cautious attitudes toward efficacy and show a substantial concern about antibiotic resistance.

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