Doxy PEP has become known as the “morning after pill” for sexually transmitted infection (STI) prevention. It's a specific use of doxycycline — a common antibiotic — taken after sex to help protect against some STIs.
Pam Layton, Clinical Supervisor and Paul Nemeth, Community Health Specialist work at Red Door, a sexual health clinic in Minneapolis. The clinic has prescribed Doxy PEP to more than 1,900 patients since December 2023.
Doxy PEP empowers patients to have safer sex on their own terms – and it may be a crucial aspect of alleviating disparities in STI rates.
STIs are common. In 2023, there were over 31,000 STI cases in Minnesota according to the Minnesota Department of Health.
For decades, public health approached STI prevention through the lens of personal responsibility – the idea that individuals should make sexual decisions that prevent STIs and that STIs are a result of irresponsible behavior. This approach ignores how social conditions like poverty or education influence people's well-being – factors known as social determinants of health.
Red Door staff know that meaningful sexual health care requires a more collaborative approach. For over 55 years, clinic staff have created an affirming space where patients can discuss their sex lives. They do this by building genuine, trustful relationships first.
The dedication to their patients is reciprocal. “People drive hours to come see us,” said Layton. Nemeth says many Red Door patients have primary care providers who don’t know much about sexual health, or whom they don’t feel comfortable discussing their sex lives with – so they look to Red Door.
Clinic staff connect patients to sexual health education and tools based on conversations they have with each patient. Individualized care means people access the tools they need.
One of those tools is Doxy PEP.
Part of what makes Doxy PEP work is that it’s easy to use and there are few drawbacks.
The American Chemical Society reports that doxycycline has been prescribed for over 50 years to treat bacterial infections like acne, malaria, tick-borne pathogens, and STIs.
The Doxy PEP regimen is one 200mg dose of doxycycline within 72 hours after sex. The sooner Doxy PEP is taken after sex, the better it will work. Side effects may include mild digestive upset, but many people have no issues at all.
Clinic staff collaborated with the County's Public Health Communications team to create materials that help patients learn how to use Doxy PEP.
The flexibility Doxy PEP offers is making a difference for STI prevention.
Red Door data shows the following reductions in STI diagnoses among patients 6 months after they started Doxy PEP:
Ultimately, Doxy PEP provides peace of mind to patients.
“There's a lot of stigma around talking about sex. So, a lot of folks come in [to the clinic] feeling really anxious about sex, about STIs, about HIV,” said Nemeth. Doxy PEP helps reduce that anxiety and gives patients more choices around how to have safer sex.
While there are other STI prevention options like condoms, Nemeth and Layton say they don't work for everyone. Because condom use isn’t the best solution for every patient, Layton says, “Doxy PEP is timely.”
STI data help Red Door assess who may benefit from Doxy PEP the most. This includes Black and Latino men who have sex with men, communities who experience disparities in STI rates due to social determinants of health.
Red Door's clinic data shows that while some racial health disparities in gonorrhea and chlamydia rates still exist among patients, many of those disparities are shrinking with Doxy PEP use. Clinic staff recognize there are barriers to Doxy PEP access for many communities, and they're developing creative solutions to alleviate those barriers.
Layton prescribes PrEP (pre-exposure prophylaxis) to patients, a medication that’s over 99% effective at preventing HIV. Both she and Nemeth help patients start and maintain their PrEP use over time. These ongoing relationships mean that patients receive regular updates about new sexual health topics like Doxy PEP.
“We’re really trying to streamline our services by discussing Doxy PEP at every PrEP visit,” Layton said.
To promote equitable access, Red Door also keeps doxycycline on hand in the clinic to give to patients without insurance.
Red Door’s outreach team talks about Doxy PEP with residents in community settings too, ensuring they know about their prevention options even if they never visit the clinic.
"A lot of folks struggle with going to the pharmacy. Spanish-speaking folks have to navigate a language barrier,” said Nemeth. “We’re putting it directly in folks' hands, and they’re more likely to use it.”
According to the Edelman 2025 Trust Barometer report, people trust their peers to give them health information about as much as they trust their doctors. Knowing that community is a trusted source of health advice, Red Door is working to bridge the divide between public health and peer support.
Community care and activism has played a role in sexual health for a long time. Cathy J. Cohen’s article in GLQ: A Journal of Lesbian and Gay Studies outlines the work of AIDS activist groups in the 1980s. ACT UP distributed condoms to their communities and taught people about how to use them. They opened needle exchange programs to help prevent HIV transmission through sharing needles.
Today, community care is still a crucial part of sexual health.
Word of mouth has been a strong tool in expanding Doxy PEP use, especially for communities experiencing the highest rates of STIs and HIV due to social determinants of health.
“The Black gay man sitting in front of you may have other Black gay friends. And having those conversations and encouraging them to talk about these different tools with their network and communities is so valuable,” Layton shared.
Antibiotic resistance has been a concern in conversations about Doxy PEP.
Red Door participates in a national surveillance program that monitors resistance to gonorrhea, an infection that health care professionals are particularly worried about.
"Our patients are getting the information as we're getting it,” Layton said. “And we can actually reassure our patients like we're not seeing any resistance in Minnesota, especially with gonorrhea.”
While research on Doxy PEP effectiveness has only successfully been conducted on people assigned male at birth who have anal sex with other people assigned male at birth, Layton says, “theoretically it should work for anyone who is sexually active.”
More research is needed to assess Doxy PEP’s effectiveness for people assigned female at birth. For now, it comes down to shared decision-making between a patient and their provider. For instance, people in the sex work industry who were assigned female at birth and have vaginal sex may choose to use Doxy PEP, even though we don’t know exactly how protective the medication is for vaginal sex. Some protection is better than none, and patients can weigh the pros and cons to decide what’s best for them.
“When you use those tools, you're able to worry less and enjoy your sex. Ultimately, that's what we want for folks: Happy sex lives,” Nemeth said.
People are taking control of their sexual health – and with more tools, the support of community, and health care resources from entities like Red Door, they no longer have to do it alone.
