Syphilis primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]Muhammad Saad, M.B.B.S.[3]

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## Overview

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There is no vaccine available for prevention of syphilis.[1][2] However, effective measures for the primary prevention of syphilis include abstinence from intimate physical contact with an infected person, consistent use of latex condoms, limiting number of sexual partners, avoidance of sharing sex toys, practising safe sex, routine screening in pregnant females, individuals with high risk behaviours, and those residing in highly prevalent areas.

## Primary prevention

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Effective measures for the primary prevention of syphilis include:[1][2][3]

* Abstinence from intimate physical contact with an infected person
* Consistent use of latex condoms
* Limiting number of sexual partners
* Avoid sharing sex toys
* Practicing safe sex
* Routine screening in pregnant females, individuals with high risk behaviors, and those residing in highly prevalent areas

### DoxyPEP:

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Doxycycline post-exposure prophlyaxis, a prevention strategy in which individuals take 200 mg of doxycycline within 72 hours after unprotected oral, anal, or vaginal sex reduces the relative risk of syphilis infection in men who have sex with men and transgender women by 77% to 88% per quarter, and the absolute risk by 18.7% to 21.2% per quarter.[4][5][6][7][8] Following table outlines the recommended approaches:[9][10][11][12]

DoxyPEP recommendations by organization  Population | CDC | International AIDS Society

|
|

MSM and transgender women | MSM and transgender women with a history of Bacterial STIs in the past year should be counseled on and offered doxyPEP through shared-decision making as part of comprehensive sexual health

DoxyPEP could also be discussed through shared decision-making with MSM and transgender women who have not had a bacterial STI during the prior year but who will be participating in sexual activities known to increase risk of STI exposure.

| DoxyPEP is recommended within 72h after unprotected sex for cisgender men who have sex with men and transgender women, regardless of HIV status
Other populations and comments | Clinicians should use their clinical judgement and shared-decision making to inform use of doxyPEP with populations not part of CDC recommendations.  | Pharmacokinetic modeling suggests that doxyPEP is effective for vaginal exposures and is recommended on a case-by-case basis for cisgender women at risk

## References

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1. ↑ 1.0 1.1 Stamm LV (2010). "Global challenge of atibiotic-resistant Treponema pallidum". Antimicrobial Agents and Chemotherapy. 54 (2): 583–9. doi:10.1128/AAC.01095-09. PMC 2812177. PMID 19805553. Retrieved 2012-02-21. Unknown parameter `|month=` ignored (help)
2. ↑ 2.0 2.1 Cameron CE, Lukehart SA (2014). "Current status of syphilis vaccine development: need, challenges, prospects". Vaccine. 32 (14): 1602–9. doi:10.1016/j.vaccine.2013.09.053. PMC 3951677. PMID 24135571.
3. ↑ http://www.cdc.gov/std/tg2015/syphilis.htm Accessed on September 27, 2016
4. ↑ "Postexposure Doxycycline to Prevent Bacterial Sexually Transmitted Infections | New England Journal of Medicine".
5. ↑ "Doxycycline Postexposure Prophylaxis and Sexually Transmitted Infections | Emergency Medicine | JAMA | JAMA Network".
6. ↑ Molina JM, Charreau I, Chidiac C, Pialoux G, Cua E, Delaugerre C, Capitant C, Rojas-Castro D, Fonsart J, Bercot B, Bébéar C, Cotte L, Robineau O, Raffi F, Charbonneau P, Aslan A, Chas J, Niedbalski L, Spire B, Sagaon-Teyssier L, Carette D, Mestre SL, Doré V, Meyer L (March 2018). "Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial". Lancet Infect Dis. 18 (3): 308–317. doi:10.1016/S1473-3099(17)30725-9. PMID 29229440.
7. ↑ Rice-Evans C, Rush J, Omorphos SC, Flynn DM (December 1981). "Erythrocyte membrane abnormalities in glucose-6-phosphate dehydrogenase deficiency of the Mediterranean and A-types". FEBS Lett. 136 (1): 148–52. doi:10.1016/0014-5793(81)81235-5. PMID 7319058.
8. ↑ "Efficacy of postexposure prophylaxis with doxycycline (Doxy-PEP) in reducing sexually transmitted infections: a systematic review and meta-analysis | Sexually Transmitted Infections".
9. ↑ "CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024 | MMWR".
10. ↑ "Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society–USA Panel | HIV | JAMA | JAMA Network".
11. ↑ "CROI Webcasts: Game Changers in Prevention of HIV and Sexually Transmitted Infections - Madeline Sankaran".
12. ↑ Tantalo LC, Luetkemeyer AF, Lieberman NA, Nunley BE, Avendaño C, Greninger AL, Celum C, Giacani L (March 2025). "In Vitro Exposure of Treponema pallidum to Subbactericidal Doxycycline Did Not Induce Resistance: Implications for Doxycycline Postexposure Prophylaxis". J Infect Dis. 231 (3): 729–733. doi:10.1093/infdis/jiae381. PMC 11911782 Check `|pmc=` value (help). PMID 39067061 Check `|pmid=` value (help).

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