This is a story about a test of using antibiotics right after sex to reduce the spread of sexually transmitted diseases in men who have sex with men and use no condoms.
On the plus side, readers who stick with the story to the end are given many warnings from the researchers and independent sources about the risks of deploying such a strategy. In that respect this is a very thoroughly reported story.
However, the story implies the results may be relevant to the general population even though the people included in the study have a risk of syphilis, for example, that is more then 1,000 times higher than the general population. All men in the study were also taking antiviral prophylaxis against HIV infection.
Much of our concern about the story stems from the overly broad headline, and we’re the first to acknowledge that reporters often have little control over that key aspect of their work. Nevertheless, we think it’s something that needs to be addressed if readers are to receive an accurate picture of the research and its relevance.
This is an important topic because rates of sexually transmitted infections remain high, especially among high-risk populations, and a safe and effective means of preventing them would be big news. News stories such as this, however, should be very clear about the potential relevance of studies to general readers. A more complete description of the study population (and of the long history of other studies that have looked at using antibiotics to prevent sexually transmitted diseases) would have helped readers understand just how specific and limited the results of this study are.
The story does not address the cost of preventative use of doxycycline. Based on the average use in this study of about seven pills per month, the cost of the drug might be about $30/month. But that cost does not include regular lab testing, which the study authors said should be mandatory in this sort of high-risk group. The cost of clinic visits also was not addressed in the story. Even though doxycycline is not an expensive drug by itself, any plan for widespread, routine use would entail much more than just paying for pills. We also think it would be interesting to consider the cost-effectiveness–does the reduced disease burden reduce costs, too?
The story gives some relative reductions, but doesn’t provide enough comparative data to give readers the scope of the benefits. For example, overall, without the antibiotic, the rate of new infection, given that condoms were not used, was 42% (45 men), and with the antibiotic, 22% (28 men).
Also, the story implies that there might be a benefit for anyone who is sexually active. Although it notes that the study participants were “men who had frequent unprotected sex with a number of male sex partners,” the story does not make clear just how unusual the men in the study were. For example, while the story reports that syphilis rates for the general US population have risen to almost 9 per 100,000 during a year, the syphilis infection rate in the control group was 11 percent (that is, 11 per 100, not 100,000) over 9 months; a rate that is more than 1,000 times the rate in the general population. The story should have made the point that the men in the study do not resemble the general population.
The body of the story spells out many of the potential harms, but the story would have been stronger if warnings had been included in the headline and lead paragraphs. The headline refers to “raising tough new questions” and the second sentence in the story says the strategy “could spark a controversy.” The potential harms would have been clearer to readers if the headline and lead had bluntly stated that routine use of doxycycline could undermine the effectiveness of antibiotics for a range of infections, not just the sexually transmitted diseases these researchers looked at.
The story reports that it was a short-term, open-label randomized trial (participants knew whether or not they were taking antibiotics) that included 232 men who had frequent unprotected sex with a number of male sex partners.
The story includes several comments from the researchers and others warning that this sort of strategy should be considered only for short-term use in special circumstances. However, that message follows a headline and lead that imply a more general relevance.
A strength of the story is that it includes multiple independent sources. It reports funding from the Bill & Melinda Gates Foundation. However, the story does not report funding from a French government agency, nor does it refer to the lengthy list of industry financial ties that many of the researchers disclosed. But we will give the story a satisfactory rating because doxycycline is available as a generic drug produced by a number of companies, not just those the researchers have ties to.
The story should have noted that this study did not compare the approach of routinely taking a pill after sex to a more conventional approach of regular testing followed by treatment when an infection is found.
The story makes clear that doxycycline is widely available and that it is used to treat other diseases, including acne.
A summary box in the journal article states that what is new about this study is that it tested an antibiotic in a group of very high-risk men who have sex with men and who were already enrolled in a trial of a drug that may reduce the risk of HIV infection. This very narrow scope is largely lost in the story.
The story includes quotes with researchers and independent sources that appear to be from original reporting.