Acceptability of doxycycline prophylaxis, prior antibiotic use, and knowledge of antimicrobial resistance among Australian gay and bisexual men and non-binary people

Background There is growing interest in novel sexually transmissible infection (STI) prevention strategies, including doxycycline post-exposure prophylaxis (doxy-PEP). We assessed interest in doxy-PEP and other STI prevention strategies among gay and bisexual men and non-binary people in Australia, as well as prior antibiotic use for STI prevention, and knowledge of antimicrobial resistance (AMR). Methods We conducted a national, online survey in June-July 2023. Multivariable logistic regression was used to identify factors associated with the acceptability of doxy-PEP. Results Of 2,046 participants, 26.9% had been diagnosed with an STI in the previous year. Condoms were rated as an acceptable STI prevention strategy by 45.1% of the sample, STI pre-exposure prophylaxis by 54.0%, and doxy-PEP by 75.8%. Previous antibiotic use for STI prevention was reported by 7.5% of the sample, and 2.6% were currently using antibiotics for STI prevention. Over half the sample (62.1%) had some knowledge of AMR. Of those who knew something about AMR,76.2% were concerned about it. Interest in using doxy-PEP was independently associated with previous use of antibiotics for STI prevention (adjusted odds ratio 3.09, 95%CI = 1.78-5.35, p < 0.001), while those who were concerned about AMR were less interested in it (AOR 0.51, 95%CI = 0.36-0.72, p < 0.001). Conclusions Doxy-PEP was highly acceptable to gay and bisexual men and non-binary people in Australia, and few factors distinguished between interest in using it or not. We recommend community and professional discussion and education about the effective use of doxy-PEP, AMR, and who would most benefit from doxy-PEP.