Sebastian Meier, Health Specialist, Checkpoint Zurich

Given the dramatic increase in congenital syphilis, the control of STIs is urgently needed. This study provides evidence that DoxyPrEP can reduce the incidence of STIs in cisgender female sex workers (FSWs), a group with limited clinical data.

The study shows that the infection rate decreases, but the vaginal flora is negatively affected. Another study also investigated PrEP for cis, which also shows that the psychological pressure on sex workers to have sex without a condom increases. This then leads to higher infection rates of STIs, so the question must be asked whether Doxyprep is really an improvement.

In my opinion, it is wrong to use antibiotics when there are no symptomatic STIs. We know they are in short supply and should use them as sparingly as possible. I think it's good that PrEP is given in special cases (especially if customers belong to a group with an increased risk), but it should be used as additional protection to the condom. In the event that it breaks or the client commits ‘stealing’, the sex worker is still protected against HIV. With PrEP, however, additional requirements must be met, such as good medical care and adherence.

I also think that the studies show too little about the influence of long-term antiobiosis. We still don't know enough about the long-term effects on the body, what happens to the vaginal/intestinal flora, why hasn't it been investigated what influence it has. What about mental health, is there an increase in depression, sleep disorders or other complaints?

More holistic studies are needed that take all these questions into account.