US CDC Encouraged People to Take Post-Sex Pill to Combat Rampant Rise in STI's | Hacker News Reader

US CDC Encouraged People to Take Post-Sex Pill to Combat Rampant Rise in STI's

telegraph.co.uk

31 pointsDocFeind25 comments

I am really worried they are compromising the effectiveness of antibiotics here. I had thought this isn't a pill you should just be using at random in your day to day life.

Mentioned in the article:

> However, antimicrobial resistance experts have hit back at the proposals. Widespread use of doxycycline as a preventive measure could contribute to mutations that make bacteria resistant to the drug, they warned.

that drug is already so badly prescribed that most bacterias already have evolved around it.

This smell as a last ditch effort when the industry paid someone to pass this recommendation so that they can cash on the last days as an expensive antibiotic by being abused as over the counter remedy. ...before it fades out of existence thanks to the previous cash out tactics they employed.

> This smell as a last ditch effort when the industry paid someone

I don't think corruption is a useful first assumption. Most people are not corrupt, in particular in the OECD countries.

Making corruption legal by calling it lobbying doesn't shield the OECD from critique.

That ship has sailed with Doxycycline so I think in this case it's probably OK.

In general however I agree with your concern.

There's always more bugs that can grow a resistance. Just because the situation is bad doesn't mean we ought to aim for making it worse.

It’s briefly covered in the article, but encouraging healthy members of the public to just pop antibiotics for prophylaxis seems like a recipe for disaster. There are obvious problems with antibiotic resistance, and multiple resistant versions of gonorrhoea and syphilis (and others including non-STD infections) are of serious concern.

On a less apocalyptic note, antibiotics have bowel side effects I’m sure most people here are familiar with. These also increase the long term risk of various diseases like Crohn’s disease. These side effects are totally tolerable compared to an active infection, but there’s no reason to subject healthy people to them for questionable benefit.

Doxycycline can also reduce the effectiveness of certain forms of birth control.

Maybe the strategy is the hope that if you're unable to control your bowel movements, you're less likely to engage in risky sexual behavior? /s :D

Does taking an antibiotic in response to an active infection reduce the likelihood of contributing to antibiotic resistance compared to a (presumptively lower dose) taken prophylactically?

The article says that prophylactic doxycycline lead to a 50-90% reduction in STIs, which seems like a reasonably good trade off, especially if a full course of antibiotics for an infection also contributes to antibiotic resistance.

My concern is that while doxycycline may be considered by some as a "commodity" the general class of tetracyclines is not. If you reference the linked antibiotic sensitivity chart, you'll notice that tigecycline is very broadly useful and in some cases one of two drugs that work [1]. Increasing the number of people who are taking doxycycline will expose additional pathogens to tetracyclines and cross resistance is definitely a thing. We are already seeing tigecycline resistant pathogens from agricultural use of doxycycline [2]. I'm sure that the people making these decisions are better informed about such things than I am but I do believe that we are vastly overusing anti-microbial agents in ways that future generations will come to regret.

1.https://therapeuticseducation.org/sites/therapeuticseducatio...

2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8557919/

I hadn't considered that resistance would affect an entire class of antibiotics, but that does seem worth taking into consideration.

More broadly speaking, what I'm having difficulty determining is if you wind up with less resistance by having 100 healthy people take 1 potentially unneeded dose of antibiotics if it prevents 10 sick people from needing to take a 10 day course of the same antibiotics. I'd hope that something like this is taken into account when the CDC makes these recommendations and it's not just the STI department trying to hit a certain metric at all costs.

Resistance doesn't build in the course of days, taking only one pill ensures that bacteria with a mild but not total resistance survive it and then the next time you take the pill there are more of those bacteria hanging around, and one or two of those has yet stronger resistance.

This is why every time you take antibiotics the doctor will tell you over and over and over that you have to take the whole bottle

I agree but I felt like giving a slightly different explanation. It is not guaranteed that you are exposed to only one variant of a pathogen as they are constantly undergoing mutation. By increasing the exposure to an antimicrobial agent, selective pressure is applied against susceptible organism variants which will increase the overall proportion of a global population that are resistant to that agent. The mitigation for this is to take enough of the antibiotic to destroy these variants as well, although this is a somewhat "leaky" containment task as you may spread the pathogen to others while undergoing treatment. This analysis so far neglects that there are other microbes in your system that you are also exposing to the antibiotic even nonpathogenic organisms that we don't normally consider when discussing antibiotic resistance. However, due to horizontal gene transfer, even nonpathogenic organisms can potentially share any developed resistances with pathogenic organisms at a later time. The only real way to protect antimicrobial agents from resistance growth is to use them extremely sparingly. Multi-drug resistant organisms have gotten bad enough that they have brought back the use of Colistin, a very old and fairly toxic drug that had fallen out of use for decades to use in cases where no other drugs work. If the world continues using these drugs at the current rate, we may see things like this become far more common.

Fundamentally we are in a war, pitting our multicellular intellect and biotechnology against our single celled brethren. It isn't as lopsided of a battle as it should be. What bacteria etc lack in individual strength, they more than make up for in multitude. I am fairly confident that in the long run we will out-innovate them but the needed systemic incentives are not currently in place to sustain our technological advantage at the present rate of resistance development.

The absolute last thing they would recommend though is to stop the rampant hook up culture in the first place. For some reason people are really touchy about this suggestion.

The real risk, of course, is that this has some strange motivation like "we want to reduce the number of infected people interacting with our healthcare workers" or something like what they did for masks and COVID.

1. Use condoms

2. Don't put bits into bits that appear shades of festering traffic signals

3. Avoid anyone with herpes

1. Condoms are only partially effective 2. Many STIs are asymptomatic 3. See #2

Unpopular opinion: don't have sex with random people and you wont get STI's.

Unless your long-term monogamous partner cheats on you. My friend's mother caught syphilis that way. I'm sure shaming people helps lower STI rates though, right?

Yes it does.

Notice how STDs were far far less prevalent in the past than they are today, and far less prevalent in countries with a healthier attitude on relationships and sex.

To your example specifically: don’t cheat either? Are you implying that “people cheat on each other, so there should be no moral standards”?

https://wisevoter.com/country-rankings/std-rates-by-country/...

Most of the countries ranked low on that list practice arranged marriages with no premarital sex. Is this what you're advocating for? Because I'd bet most Americans and Europeans don't want to live that lifestyle.

For some STIs the main consequence is the stigma in the first place. Creating more stigma to reduce

Ugh, I hit reply too early and the client I'm using doesn't support editing comments.

I'm busy at work and OP is probably not going to change their mind, so I'm leaving this.

I’m a little confused at the notion that shame doesn’t functionally work. I thought it was regarded as like, mean, not ineffective. But I see people say this sort of thing a lot. Are there studies or something on shame not working?

This is just obviously false.

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