Acceptability and Interest in Doxycycline Postexposure Prophylaxis in Emergency Department Patients

Doxycycline post-exposure prophylaxis (Doxy PEP) reduces bacterial sexually transmitted infections (STIs) in high-risk populations, but its acceptability among emergency department (ED) patients is unknown. EDs provide an important access point for STI prevention, yet patient perspectives to guide implementation remain limited. This study evaluated awareness, perceptions, and interest in Doxy PEP among ED patients eligible for STI prevention interventions.

We conducted a prospective survey of English-speaking adults meeting risk-based criteria aligned with CDC guidance for Doxy PEP in an urban ED. After screening and consent, participants completed an investigator-developed survey assessing STI history, awareness, acceptability, anticipated behavioral effects, and preferred access modalities. Descriptive statistics were used to analyze responses.

Among 542 patients screened, 41 (7.6%) were eligible and 28 (68% of eligible) enrolled. Most (75%) were 18–34 years old and identified as female (57%); 21% reported an STI in the prior year. Awareness of Doxy PEP was low (39%), but interest was high: 64% would consider taking Doxy PEP and 50% were “very likely” to recommend it if widely available. Most (64%) reported it would make them feel more comfortable engaging in sex, and 43% said Doxy PEP would increase their likelihood of STI testing. The factors most influencing use were side effects (53%) and effectiveness (40%). Only 12% anticipated increased risk behaviors. Preferred access points included outpatient clinics (64%) and the ED (32%). Most (54%) felt receiving Doxy PEP in the ED would increase their likelihood of using it.

ED patients eligible for STI prevention services show high interest in Doxy PEP despite limited prior awareness. Participants reported anticipated benefits without anticipated major risk compensation, and many preferred ED-based access. These findings could potentially support the ED as a feasible venue for Doxy PEP implementation and help inform future program design.