We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

SAMP

Kevin Labrone, a 28-year-old man, presents for sexual health follow-up. He identifies as a gay man and reports 8 partners over the past year with inconsistent condom use. He completed treatment for rectal chlamydia 6 months ago. He is currently taking HIV pre-exposure prophylaxis (PrEP). He read a poster about “taking antibiotics after sex to prevent STIs” and would like to learn more about what this entails. He has no known drug allergies. He has a history of mild asthma. (9 points)

1. What is the appropriate doxycycline postexposure prophylaxis (doxyPEP) regimen? Be specific. (1 point)

   Answer:
   Doxycycline 200 mg orally – taken within 72 hours after condomless sex
   Maximum 200 mg per 24 hours

2. Which of the following patients are appropriate candidates for doxyPEP? List two. (2 points)

   Answer:
   Gay, bisexual, and other men who have sex with men with an STI in the past 12 months
   Transgender women with an STI in the past 12 months

3. List three counselling points that should be discussed when prescribing doxyPEP? (3 points)

   Answer:
   Avoid dairy, antacids, and mineral supplements within 2 hours of dosing
   Take with a full glass of water
   Remain upright for at least 1 hour after ingestion
   Risk of gastrointestinal side effects
   Photosensitivity risk
   Need for STI screening at baseline and every 3-6 months
   Does not replace other STI prevention strategies

4. Which of the following best describes the effectiveness of doxyPEP? (1 point)
   1. No reduction in gonorrhea rates
   2. Reduces the risk of any bacterial STI by about 20%
   3. Reduces the risk of any bacterial STI by about 60%
   4. Eliminates the need for STI screening
   5. Only effective for syphilis

   Answer: C

5. Which of the following is a contraindication or an important drug interaction with doxycycline? (1 point)
   1. Acetaminophen
   2. Calcium supplements taken at the same time
   3. Mild asthma
   4. Topical corticosteroids
   5. SSRIs

   Answer: B

6. Which of the following statements regarding antimicrobial resistance and doxyPEP is most accurate? (1 point)
   1. Resistance is not a concern with intermittent doxycycline use
   2. Routine culture is unnecessary in symptomatic gonorrhea
   3. Monitoring for resistance, particularly in Neisseria gonorrhoeae, is recommended
   4. DoxyPEP eliminates resistant organisms
   5. Resistance concerns outweigh all benefits

   Answer: C

Helpful CMAJ Resource:
https://www.cmaj.ca/content/197/19/E534