A single-dose ‘morning after’ pill could be introduced to tackle the UK’s soaring rates of syphilis.

New guidance is being drawn up on the use of doxyPEP – the antibiotic doxycycline – which trials have shown can be given within 24 hours of unprotected sex to prevent the potentially life-threatening sexually transmitted infection (STI) from developing.

Experts say the approach could be ‘a valuable tool’ in fighting syphilis, which was almost eradicated in the UK in the 1990s but has re-emerged in recent years.

Doxycycline, which costs pennies, is already prescribed to treat syphilis as well as chlamydia, another STI, and is typically taken every day for up to two weeks to eradicate the infection. However, research into the effect of a single high dose found it could stop the infections from taking hold.

The study involved about 500 participants who’d had an STI in the previous year. Some were given doxyPEP to take after condomless intercourse – including oral sex – alongside the standard care of regular three-monthly STI tests and treatment if an infection was spotted. Others were given the standard care without doxyPEP.

A single-dose ‘morning after’ pill could be introduced to tackle the UK’s soaring rates of syphilis

A single-dose ‘morning after’ pill could be introduced to tackle the UK’s soaring rates of syphilis

The risk of syphilis infection – which can cause serious heart and brain problems – was almost 90 per cent lower in the doxyPEP group and STI infections were down two-thirds overall.

In October, US regulators the Centers for Disease Control (CDC) issued guidance recommending doxyPEP to reverse the country’s syphilis crisis, which has seen an 80 per cent rise in cases since 2018. The sharpest increases have been in the most deprived areas, where access to healthcare is scarce.

The major concern in the US is that the disease can be passed by mothers to babies during pregnancy or shortly after birth.

Known as congenital syphilis, this can have tragic outcomes, including miscarriage, stillbirth, infant death and lifelong medical issues.

More than 3,700 babies in the US were born with syphilis in 2022.

The risk of syphilis infection – which can cause serious heart and brain problems – was almost 90 per cent lower in the doxyPEP group and STI infections were down two-thirds overall

The risk of syphilis infection – which can cause serious heart and brain problems – was almost 90 per cent lower in the doxyPEP group and STI infections were down two-thirds overall

‘The US has a major problem with congenital syphilis, and that’s what we’re most anxious about if cases continue to rise,’ said Dr John McSorley, a London consultant in genitourinary and HIV medicine.

‘In the UK it’s mainly affected men who have sex with men.’

Last month it was reported that sexual health services in England were grappling with ‘unprecedented’ increases in demand. Two-thirds of council areas saw increases in rates of syphilis and gonorrhoea, according to the Local Government Association (LGA). Overall there was a 76 per cent rise in syphilis rates and a 36 per cent rise in chlamydia.

An LGA analysis found that, between 2015 and 2024, the public health grant received by councils was reduced by £880 million, resulting in a reduction in STI testing, contraception and treatment.

Professor Matt Phillips, president of the British Association for Sexual Health and HIV (BASHH), which is responsible for producing sexual health treatment guidance for doctors, said its working groups were ‘taking care’ to produce guidance on doxyPEP for the UK.

‘We are trying to understand who it might be useful for,’ he said. ‘It will be a useful tool for the right people.’ He added that the ‘spectre’ of drug-resistant superbugs looms large. In the UK, another common infection, gonorrhoea, is increasingly immune to doxycycline and other first-line antibiotics.

Antibiotic resistance occurs when bacteria are exposed to medications but not killed by them completely, which can happen if patients don’t complete the course.

Last month it was reported that sexual health services in England were grappling with ‘unprecedented’ increases in demand

Last month it was reported that sexual health services in England were grappling with ‘unprecedented’ increases in demand

Surviving bacteria can evolve defence mechanisms against the antibiotic. Once these multiply, they’re much harder to treat.

‘There is the worry that if people take doxyPEP when they unknowingly have gonorrhoea, it could worsen drug-resistance,’ said Prof Phillips. ‘We would have to make sure patients given doxyPEP came for regular check-ups.’

Dr McSorely added that doxyPEP would be recommended alongside standard approaches. ‘Syphilis takes up to three months to cause symptoms, and in that time people can pass it on unwittingly,’ he said.

‘We recommend all sexually active people should be tested once a year, and if you’ve had a new partner you should also get tested.

‘If it’s picked up, we have 100 per cent effective treatments and can carry out contact tracing, which is the best way to catch the infection in people who are asymptomatic.

‘A third of people diagnosed with syphilis had no idea there was anything wrong. We also encourage condom use as they are highly effective in preventing most STIs.’

Some private clinics online are promoting doxyPEP, claiming it is ‘a no brainer’ to avoid syphilis.

But Dr McSorley urged caution. ‘The dose in doxyPEP is high – on an empty stomach it would probably make you throw up,’ he said. ‘It can also cause photosensitivity, when the skin blisters when exposed to even mild sunlight.’

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