{
  "abstract": "Rising global rates of bacterial sexually transmitted infections (STIs) have renewed attention to biomedical prevention strategies, including doxycycline postexposure prophylaxis (doxy-PEP). While doxy-PEP reduces the risk of syphilis and chlamydia, its widespread use may accelerate antimicrobial resistance (AMR), threatening long-term effectiveness. In 2024, the US Centers for Disease Control and Prevention (CDC) recommended doxy-PEP for men and trans* women who have sex with men with a bacterial STI in the past 12 months. The recommendation also allows clinicians to apply broader criteria for those engaging in activities where exposure is likely. Moreover, this guidance promotes a patient-managed prevention strategy, shifting responsibility for antibiotic use towards individual decision-making.This paper examines the CDC recommendation using an ethical framework integrating sustainability with intergenerational and social justice. We assess empirical evidence, ethical trade-offs and implementation challenges at individual, population and societal levels. Our analysis highlights knowledge gaps regarding long-term resistance, microbiome effects, behavioural dynamics and risks associated with unsupervised antibiotic use. As the targeted populations face structural stigma and barriers to sexual healthcare, precautionary restrictions could exacerbate inequalities. Conversely, neglecting long-term AMR risks threatens future therapeutic capacity and global public health.We argue that sustainable STI prevention must balance immediate benefits with collective and future harms and foster non-antibiotic strategies. Accordingly, doxy-PEP should be reserved for high-risk groups and integrated into programmes that include regular testing, education and community-based interventions. Ongoing ethical and empirical review is essential to ensure that biomedical STI prevention strategies remain effective, equitable and sustainable.",
  "authors": [
    {
      "affiliations": [
        "Department of Medical Ethics, Institute for Experimental Medicine, Kiel University, Kiel, Germany",
        "Institute for Medical Ethics, History and Philosophy of Medicine, University of Münster, Münster, Germany"
      ],
      "name": "Stefanie Weigold"
    },
    {
      "affiliations": [
        "Department of Evolutionary Ecology and Genetics, Kiel University, Kiel, Germany"
      ],
      "name": "Florian Buchholz"
    },
    {
      "affiliations": [
        "Infectious Diseases Clinic, University Hospital Schleswig-Holstein Lübeck Campus, Lübeck, Germany",
        "Infectious Diseases Clinic, University of Lübeck, Lübeck, Germany"
      ],
      "name": "Benjamin Gebel"
    },
    {
      "affiliations": [
        "Infectious Diseases Clinic, University Hospital Schleswig-Holstein Lübeck Campus, Lübeck, Germany",
        "Infectious Diseases Clinic, University of Lübeck, Lübeck, Germany",
        "Institute of Medical Microbiology, University Hospital Schleswig Holstein, Kiel, Germany"
      ],
      "name": "Jan Rupp"
    },
    {
      "affiliations": [
        "Department of Evolutionary Ecology and Genetics, Kiel University, Kiel, Germany",
        "Max Planck Institute for Evolutionary Biology, Plön, Germany"
      ],
      "name": "Hinrich Schulenburg"
    },
    {
      "affiliations": [
        "Institute for Medical Ethics, History and Philosophy of Medicine, University of Münster, Münster, Germany"
      ],
      "name": "Claudia Bozzaro"
    }
  ],
  "title": "Antibacterial morning-after pill: why ‘doxy-PEP’ might not be a sustainable public health strategy for preventing sexually transmitted infections",
  "uid": "e61a4eff-2ba0-5ea4-b5f0-b10a329fd144"
}