Abstract
OBJECTIVES: This study examines the perceptions and acceptability of daily doxycycline-based prophylaxis (Doxy-PrEP) for bacterial sexually transmitted infections (STIs) among populations at heightened risk of STIs and healthcare providers in Queensland, Australia. It explores factors influencing willingness to use or prescribe this intervention, including potential ethical and clinical concerns. METHODS: Two cross-sectional online surveys were conducted in 2024 - one targeting consumers at higher risk for STIs, including gay, bisexual and other men who have sex with men, sex workers, young adults, culturally diverse people as well as Aboriginal and Torres Strait Islander Peoples (Indigenous Australians). The other survey targeted healthcare providers with prescribing rights. Recruitment was conducted via social media, community organizations and professional networks. Statistical analyses assessed demographic, behavioral and experiential predictors of Doxy-PrEP acceptability. RESULTS: Consumer perceptions of Doxy-PrEP were shaped by prior biomedical prevention use, particularly HIV PrEP, as well as age, with older participants expressing greater acceptance. Perceived STI risk and previous antibiotic use were also associated with willingness to use Doxy-PrEP. Ethical concerns focused on antibiotic resistance, reduced condom use, and healthcare burden. Among providers, awareness of Doxy-PEP was high, with most viewing it as an evidence-based practice. Support for Doxy-PrEP was more "conditional", with concerns about long-term antibiotic resistance and adherence. CONCLUSIONS: Findings highlight complex social and clinical considerations in the potential implementation of Doxy-PrEP. While consumer interest suggests a role for this intervention in STI prevention, ethical concerns and provider hesitancy require clear guidelines, education, and regulatory oversight. Future research should examine long-term implications for antimicrobial resistance and STI prevention strategies.