Learning Resources — HIV/STI Treatment and Prevention

Bacterial sexually transmitted infections (STIs) are common in the United States, with more than 1.5 million chlamydia, more than 500,000 gonorrhea, and more than 190,000 syphilis cases reported in 2024. STIs disproportionately affect people in certain sexual networks, including men who have sex with men (MSM), and where access to care or health- seeking behavior are compromised. Numerous strategies, including condom use, have been shown to reduce the likelihood of bacterial STI transmission or acquisition. More recently, the STI prevention toolkit has expanded with the addition of doxycycline post-exposure prophylaxis, an evidence-based intervention that can significantly reduce chlamydia, gonorrhea, and syphilis infections among MSM and some other populations. Doxycycline post-exposure prophylaxis consists of a single dose of doxycycline, 200 mg, taken by mouth within 72 hours after condomless sex. This publication will focus on the evidence for doxycycline post-exposure prophylaxis and its implementation at health centers.

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HIV testing is a crucial component of efforts to address the HIV epidemic. Testing for HIV identifies those with infection so that they may receive antiretroviral treatment, which both improves their health and prevents transmission of HIV to others. In addition, PrEP, which prevents HIV acquisition among people with a higher risk for infection, requires testing prior to administration. Both the Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force recommend universal HIV testing at least once in a person’s lifetime. In addition, testing is recommended in each pregnancy and at least annually for people with a high likelihood for infection, such as sexually-active men who have sex with men and people who inject drugs. Periodic testing is also recommended for people taking PrEP. Unfortunately, approximately 13% of people with HIV do not know about their HIV status. Efforts to increase testing uptake and access are needed. Expanding HIV testing can be achieved through self-testing and rapid testing.

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