Doxy-PEP in Australia: Who It’s For and How to Get It

Doxy-PEP is a newer way to lower the risk of some bacterial STIs, especially syphilis. It involves taking a single dose of an antibiotic after condomless sex. Australian sexual health experts support it for specific people at higher risk, but it isn’t for everyone.

This guide explains what Doxy-PEP is, who it’s recommended for in Australia, how well it works, and how to get it.

What is Doxy-PEP?

Doxy-PEP stands for doxy post-exposure prophylaxis. You take one dose of a prescription antibiotic after sex, ideally within 24 hours and no later than 72 hours. It works by stopping some bacterial infections before they take hold.

It’s sometimes searched for as “doxy PrEP”, but it’s taken after sex, not before. It’s also different from HIV PEP and PrEP, which prevent HIV. Doxy-PEP does not prevent HIV.

Who is Doxy-PEP for in Australia?

The Australian consensus statement on Doxy-PEP recommends it mainly to prevent syphilis in gay, bisexual and other men who have sex with men who are at higher risk. Your doctor may suggest it if you have:

• had syphilis in the last 6 to 12 months
• had 2 or more bacterial STIs recently
• a period of higher risk coming up, such as travel or a festival

There’s currently no evidence that Doxy-PEP works for cisgender women or others assigned female at birth, so Australian guidance doesn’t recommend it for them. It also isn’t used in pregnancy.

Even when it suits you, Doxy-PEP is meant for occasional higher-risk situations, such as group sex or several partners over a short time. It isn’t a routine fallback after every encounter.

How well does Doxy-PEP work?

In studies, Doxy-PEP reduced syphilis and chlamydia by roughly 70 to 80% or more. It works much less well against gonorrhoea, because many gonorrhoea strains in Australia are already resistant to this group of antibiotics.

Why isn’t Doxy-PEP offered to everyone?

The main concern is antibiotic resistance. Taking antibiotics regularly can encourage resistance, both in STIs and in the normal bacteria in your body, including the healthy bacteria in your gut. That’s why Australian experts recommend Doxy-PEP only for people most likely to benefit, and why regular STI testing continues while you use it.

How to get Doxy-PEP in Australia

1. Talk to a doctor. Doxy-PEP needs a prescription. A doctor will ask about your sexual health and recent STI tests to see if it’s likely to help you. With Doxy-PEP online through STI Doctor, this is a phone or video consult.
2. Get tested if you’re due. Your doctor can send a pathology request for an STI check at any local collection centre.
3. Receive your eScript. If Doxy-PEP suits you, your eScript is sent to your phone and you can fill it at any pharmacy.
4. Keep up regular testing. Your doctor will also review whether you still need Doxy-PEP at least every 6 months.

How much does Doxy-PEP cost?

At STI Doctor, consultations are bulk-billed for eligible Medicare card holders. The PBS only subsidises a small quantity of this antibiotic, so a supply for Doxy-PEP is usually a private script at the pharmacy. Ask your pharmacist for the price.

Doxy-PEP, PEP and PrEP compared

• Doxy-PEP: an antibiotic taken after sex to lower the risk of syphilis and chlamydia. Doesn’t prevent HIV.
• HIV PEP: a 28-day course taken after a possible HIV exposure. Must start within 72 hours.
• PrEP: taken before possible exposure, on an ongoing basis, to prevent HIV.

Some people on PrEP also use Doxy-PEP for occasional higher-risk situations, but being on PrEP doesn’t by itself mean you need it. Your doctor can help you work out what fits your situation.

Frequently asked questions

Is Doxy-PEP available in Australia?

Yes. It’s supported by Australian guidance for some people at higher risk of syphilis, and a doctor needs to assess you and prescribe it.

Can I get Doxy-PEP online?

Yes. A telehealth doctor can assess you by phone or video and send an eScript to your phone if it’s right for you.

Can I take Doxy-PEP every time I have sex?

It isn’t meant for that. Doxy-PEP is for occasional higher-risk situations, such as group sex. Taking antibiotics often can lead to resistance and affect your gut bacteria, so your doctor will help you decide when it’s worth using.

Does Doxy-PEP prevent gonorrhoea?

Not reliably. It’s much less effective against gonorrhoea than against syphilis and chlamydia.

Do I still need STI tests on Doxy-PEP?

Yes. Regular STI testing, usually every 3 months, is an important part of using Doxy-PEP safely.

Talk to a doctor about Doxy-PEP

If you think Doxy-PEP might suit you, book a bulk-billed telehealth consult. Our doctors will check whether it’s right for you and arrange any tests you need. Get Doxy-PEP online.

Sources: Australian consensus statement on Doxy-PEP (MJA, 2024); ASHM Doxy-PEP consensus statement. This article is general information, not personal medical advice.