What do men who have sex with men think of the use of antibiotics as pre- and post-exposure prophylaxis to prevent sexually transmitted infections?

OBJECTIVEClinical trials have shown that doxycycline as post-exposure prophylaxis after sexual contact (doxy-PEP) prevents sexually transmitted bacterial infections (STI). We investigated current awareness about informal use of antibiotics as pre- and post-exposure prophylaxis to prevent STI (STI-PrEP/PEP) among men who have sex with men (MSM). In addition, we investigated psychosocial determinants of its use. METHODSData were collected in the Amsterdam Cohort Study among MSM, the Netherlands, between October 2021 and October 2022. In an online questionnaire, we assessed socio-demographics, sexual behavior, bacterial STI diagnoses, STI-PrEP/PEP awareness, perceived effectiveness of, and beliefs and attitudes towards STI-PrEP/PEP, and intention to use it. STI-PrEP/PEP users were described and (ordinal) logistic regression analysis was conducted to identify factors associated with STI-PrEP/PEP awareness (yes/no) and intention to use STI-PrEP/PEP (7-point Likert scale). RESULTSAmong 593 MSM with median age 46 years (IQR 36-53), 102 (17.2%) were aware of STI-PrEP/PEP and 15 (2.5%) had ever used it. STI-PrEP/PEP awareness was associated with living with HIV, HIV-PrEP use in the preceding 6 months, and sexualized drug use with casual partner(s). Median intention to use STI-PrEP-PEP was 3 (IQR 2-4). Higher intention to use STI-PrEP/PEP was associated with HIV-PrEP use, sexual contact with casual partners, being worried to get an STI, self-protection as reason to use it, the intention to reduce STI testing and sexual experimenting. Stigmatizing beliefs regarding STI-PrEP/PEP users were associated with lower use intentions. CONCLUSIONPreventive use of antibiotics for STI prevention is limited among MSM in the Netherlands in 2021/2022. Some men have a high intention for future use. Self-protection and a wish for sexual experimenting are amongst the intrinsic motivators for higher intention to use STI-PrEP/PEP. More studies on the safe use of STI-PrEP/PEP are required as well as a strategy to educate those who have already adopted STI-PrEP/PEP or have a high intention to do so, and their healthcare providers.