Hasan Mirza: PrEP & Sexual Health Pharmacist, Ambrose King Centre, Royal London Hospital.
Sexual assault remains a global concern. In the UK, around one in four women and one in eighteen men experience rape or sexual assault after the age of 16. Yet fewer than one in six report it to the police.
It is difficult to determine STI rates linked to sexual assault due to difficulty in determining time of acquisition and variable follow-up attendance rates.
Antibiotic prophylaxis after sexual assault is handled differently around the world.
- UK guidance (BASHH) recommends case-by-case decisions rather than routine antibiotics.
- US guidelines suggest offering antibiotics (ceftriaxone, doxycycline and metronidazole) to all survivors seen within seven days.
- WHO does not recommend routine use due to limited evidence.
However, recent evidence on doxycycline post-exposure prophylaxis (doxyPEP) — a single 200 mg dose taken within 72 hours after sex — shows it is highly effective in preventing chlamydia and syphilis.
Although most research has focused on men who have sex with men, BASHH’s latest guidance now suggests doxyPEP could be considered after sexual assault on an individual basis, regardless of gender.
Offering doxyPEP may provide survivors with an important sense of control, especially when follow-up is uncertain. Using home testing kits for later screening can also reduce the need for repeat in-person examinations, helping minimise further trauma.
Women have historically been underrepresented in STI prevention research, and limited data exist on doxyPEP’s effectiveness for them. Nonetheless, not offering it risks continuing this gap in care.
Key message for SHAs:
DoxyPEP could be a useful addition to sexual assault care, supporting survivor autonomy and reducing STI risk. Decisions should be guided by clinical judgment, local protocols, and trauma-informed discussions with each individual.