Neisseria gonorrhoeae Answers Back to DoxyPEP

The rising use of doxycycline to prevent sexually transmitted infections is associated with an increase in tetracycline-resistant N. gonorrheae.

Although gonococcus is known to develop antimicrobial resistance quickly, the effects of doxycycline's increasing use for preventing STIs are unclear. In an analysis of N. gonorrheae genomic sequences identified from 2018 through 2024, investigators evaluated the presence of tetM, a plasmid-borne gene conferring high-level tetracycline resistance.

Key findings:

The proportion of isolates carrying tetM rose from <10% (2020) to >30% (2024, first quarter).
These increases reflected the transition from azithromycin to doxycycline for management of chlamydia in 2020 and the reporting of the DoxyPEP trial in 2022.
Four lineages carrying tetM have risen significantly since 2020; two of these carry penA variants that increase ceftriaxone minimum inhibi…

Reviewing Author

Carlos del Rio, MD

Disclosures

Grant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug Abuse

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes; Vaccines

Leadership Positions in Professional SocietiesInternational Antiviral Society–USA (Board of Directors); Infectious Diseases Society of America (Past President)