How one antibiotic morning-after pill came to be widely available in San Francisco

An antibiotic morning-after pill has been shown to be effective for preventing STIs among gay men, but some doctors worry about antibiotic resistance. This story discusses STIs and their symptoms.

AYESHA RASCOE, HOST: Research shows that a new morning-after pill for bacterial STIs is highly effective for gay men. A possible downside - it could lead to antibiotic-resistant superbugs. Note - this story mentions sexually transmitted infections and symptoms. KQED's April Dembosky reports from San Francisco. APRIL DEMBOSKY, BYLINE: Tyler Toler (ph) has had the trifecta of bacterial STIs - chlamydia, gonorrhea and syphilis. TYLER TOLER: Itching, burning, leaking, not able to swallow. DEMBOSKY: Then there's the awkward conversations. Toler dreaded having to tell his partners he may have exposed them to an infection. TOLER: Some people are like, yeah, cool. Thank you for letting me know. And then there's some people that think you're the dirtiest person in the face of the planet. DEMBOSKY: When Toler heard there was an antibiotic pill that could solve all these problems, he wanted in. It's called Doxy PEP, short for doxycycline post-exposure prophylaxis. Toler takes it a day or two after sex without a condom, and he hasn't had an STI in three years. TOLER: I can be as much of a promiscuous person as I possibly can and not have to worry about the ramifications as much. DEMBOSKY: In 2022, San Francisco health officials began recommending Doxy PEP for gay men and trans women who'd had any bacterial STI in the last year. The Centers for Disease Control and Prevention later adopted the same approach. Across San Francisco last year, syphilis went down 24%. Chlamydia rates dropped 18%. But gonorrhea only dipped slightly, 5%. Gonorrhea has already built resistance to this class of antibiotics. Doctors like Annie Luetkemeyer from the University of California, San Francisco, fear the rapid uptake of Doxy PEP could make it worse. ANNIE LUETKEMEYER: Need to be thoughtful about how we're using it. Antibiotics are an incredible resource. We all worry about antimicrobial resistance. DEMBOSKY: Because of this, Luetkemeyer has heard from critics who say people should just use condoms instead. But she says doctors have tried that message, and people continue to have sex without condoms. LUETKEMEYER: And if we just say, the only way you can protect yourself from HIV, from pregnancy, from STIs is using condoms, we're going to fail. DEMBOSKY: Coming up with Doxy PEP policy is a balancing act, weighing the benefits of reduced STIs against the risk of cultivating antibiotic-resistant superbugs that are harder and harder to treat. Globally, these policies have varied. The U.S. chose to go abroad, but other countries have taken a more conservative approach. European and Australian health officials recommend Doxy PEP primarily for the prevention of syphilis. Sydney doctor Vincent Cornelisse was a co-author on Australia's position statement. VINCENT CORNELISSE: I would argue that for gay men, there is no population-level benefit for getting chlamydia rates down. DEMBOSKY: He says the consequences of syphilis can be dire - blindness, hearing loss, brain damage. Chlamydia, on the other hand, is more of a nuisance for men. He says doling out antibiotics to prevent it isn't worth it. CORNELISSE: I think we need to be a bit tempered in recommending strategies to reduce chlamydia, when the strategies themselves might have adverse outcomes. (SOUNDBITE OF POURING PILLS) DEMBOSKY: At the Strut clinic in San Francisco, Dr. Hyman Scott and his colleagues offer Doxy PEP to everyone they think could benefit - men, women, gay, straight. City officials updated local guidance to match this approach in May. (SOUNDBITE OF POURING PILLS) HYMAN SCOTT: We cannot make the same mistakes with rollout that we made with PrEP. DEMBOSKY: When the medication called PrEP came out to prevent HIV, Scott says officials placed a lot of restrictions on who should get it. It was so hard to access, and the guidelines were so confusing, by 2020, only a quarter of people in the U.S. who needed it were on it. SCOTT: There's a lot of things now that we're trying to undo, I think, as a result of the way we did it originally. DEMBOSKY: Scott says they want to reduce stigma. He reminds patients that antibiotics are already prescribed preventatively for Lyme disease and malaria. If the U.S. wants to reduce antibiotic use, he argues there's a better target. SCOTT: It's in actually the food and livestock industry. That's where we have the kilograms and kilograms of these antibiotics being used. DEMBOSKY: When it comes to the widespread offering of Doxy PEP, Scott says the benefits outweigh the concerns. For NPR News, I'm April Dembosky in San Francisco. Copyright © 2026 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information. Accuracy and availability of NPR transcripts may vary. Transcript text may be revised to correct errors or match updates to audio. Audio on npr.org may be edited after its original broadcast or publication. The authoritative record of NPR’s programming is the audio record.

AYESHA RASCOE, HOST: Research shows that a new morning-after pill for bacterial STIs is highly effective for gay men. A possible downside - it could lead to antibiotic-resistant superbugs. Note - this story mentions sexually transmitted infections and symptoms. KQED's April Dembosky reports from San Francisco. APRIL DEMBOSKY, BYLINE: Tyler Toler (ph) has had the trifecta of bacterial STIs - chlamydia, gonorrhea and syphilis. TYLER TOLER: Itching, burning, leaking, not able to swallow. DEMBOSKY: Then there's the awkward conversations. Toler dreaded having to tell his partners he may have exposed them to an infection. TOLER: Some people are like, yeah, cool. Thank you for letting me know. And then there's some people that think you're the dirtiest person in the face of the planet. DEMBOSKY: When Toler heard there was an antibiotic pill that could solve all these problems, he wanted in. It's called Doxy PEP, short for doxycycline post-exposure prophylaxis. Toler takes it a day or two after sex without a condom, and he hasn't had an STI in three years. TOLER: I can be as much of a promiscuous person as I possibly can and not have to worry about the ramifications as much. DEMBOSKY: In 2022, San Francisco health officials began recommending Doxy PEP for gay men and trans women who'd had any bacterial STI in the last year. The Centers for Disease Control and Prevention later adopted the same approach. Across San Francisco last year, syphilis went down 24%. Chlamydia rates dropped 18%. But gonorrhea only dipped slightly, 5%. Gonorrhea has already built resistance to this class of antibiotics. Doctors like Annie Luetkemeyer from the University of California, San Francisco, fear the rapid uptake of Doxy PEP could make it worse. ANNIE LUETKEMEYER: Need to be thoughtful about how we're using it. Antibiotics are an incredible resource. We all worry about antimicrobial resistance. DEMBOSKY: Because of this, Luetkemeyer has heard from critics who say people should just use condoms instead. But she says doctors have tried that message, and people continue to have sex without condoms. LUETKEMEYER: And if we just say, the only way you can protect yourself from HIV, from pregnancy, from STIs is using condoms, we're going to fail. DEMBOSKY: Coming up with Doxy PEP policy is a balancing act, weighing the benefits of reduced STIs against the risk of cultivating antibiotic-resistant superbugs that are harder and harder to treat. Globally, these policies have varied. The U.S. chose to go abroad, but other countries have taken a more conservative approach. European and Australian health officials recommend Doxy PEP primarily for the prevention of syphilis. Sydney doctor Vincent Cornelisse was a co-author on Australia's position statement. VINCENT CORNELISSE: I would argue that for gay men, there is no population-level benefit for getting chlamydia rates down. DEMBOSKY: He says the consequences of syphilis can be dire - blindness, hearing loss, brain damage. Chlamydia, on the other hand, is more of a nuisance for men. He says doling out antibiotics to prevent it isn't worth it. CORNELISSE: I think we need to be a bit tempered in recommending strategies to reduce chlamydia, when the strategies themselves might have adverse outcomes. (SOUNDBITE OF POURING PILLS) DEMBOSKY: At the Strut clinic in San Francisco, Dr. Hyman Scott and his colleagues offer Doxy PEP to everyone they think could benefit - men, women, gay, straight. City officials updated local guidance to match this approach in May. (SOUNDBITE OF POURING PILLS) HYMAN SCOTT: We cannot make the same mistakes with rollout that we made with PrEP. DEMBOSKY: When the medication called PrEP came out to prevent HIV, Scott says officials placed a lot of restrictions on who should get it. It was so hard to access, and the guidelines were so confusing, by 2020, only a quarter of people in the U.S. who needed it were on it. SCOTT: There's a lot of things now that we're trying to undo, I think, as a result of the way we did it originally. DEMBOSKY: Scott says they want to reduce stigma. He reminds patients that antibiotics are already prescribed preventatively for Lyme disease and malaria. If the U.S. wants to reduce antibiotic use, he argues there's a better target. SCOTT: It's in actually the food and livestock industry. That's where we have the kilograms and kilograms of these antibiotics being used. DEMBOSKY: When it comes to the widespread offering of Doxy PEP, Scott says the benefits outweigh the concerns. For NPR News, I'm April Dembosky in San Francisco. Copyright © 2026 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information. Accuracy and availability of NPR transcripts may vary. Transcript text may be revised to correct errors or match updates to audio. Audio on npr.org may be edited after its original broadcast or publication. The authoritative record of NPR’s programming is the audio record.

Research shows that a new morning-after pill for bacterial STIs is highly effective for gay men. A possible downside - it could lead to antibiotic-resistant superbugs. Note - this story mentions sexually transmitted infections and symptoms. KQED's April Dembosky reports from San Francisco. APRIL DEMBOSKY, BYLINE: Tyler Toler (ph) has had the trifecta of bacterial STIs - chlamydia, gonorrhea and syphilis. TYLER TOLER: Itching, burning, leaking, not able to swallow. DEMBOSKY: Then there's the awkward conversations. Toler dreaded having to tell his partners he may have exposed them to an infection. TOLER: Some people are like, yeah, cool. Thank you for letting me know. And then there's some people that think you're the dirtiest person in the face of the planet. DEMBOSKY: When Toler heard there was an antibiotic pill that could solve all these problems, he wanted in. It's called Doxy PEP, short for doxycycline post-exposure prophylaxis. Toler takes it a day or two after sex without a condom, and he hasn't had an STI in three years. TOLER: I can be as much of a promiscuous person as I possibly can and not have to worry about the ramifications as much. DEMBOSKY: In 2022, San Francisco health officials began recommending Doxy PEP for gay men and trans women who'd had any bacterial STI in the last year. The Centers for Disease Control and Prevention later adopted the same approach. Across San Francisco last year, syphilis went down 24%. Chlamydia rates dropped 18%. But gonorrhea only dipped slightly, 5%. Gonorrhea has already built resistance to this class of antibiotics. Doctors like Annie Luetkemeyer from the University of California, San Francisco, fear the rapid uptake of Doxy PEP could make it worse. ANNIE LUETKEMEYER: Need to be thoughtful about how we're using it. Antibiotics are an incredible resource. We all worry about antimicrobial resistance. DEMBOSKY: Because of this, Luetkemeyer has heard from critics who say people should just use condoms instead. But she says doctors have tried that message, and people continue to have sex without condoms. LUETKEMEYER: And if we just say, the only way you can protect yourself from HIV, from pregnancy, from STIs is using condoms, we're going to fail. DEMBOSKY: Coming up with Doxy PEP policy is a balancing act, weighing the benefits of reduced STIs against the risk of cultivating antibiotic-resistant superbugs that are harder and harder to treat. Globally, these policies have varied. The U.S. chose to go abroad, but other countries have taken a more conservative approach. European and Australian health officials recommend Doxy PEP primarily for the prevention of syphilis. Sydney doctor Vincent Cornelisse was a co-author on Australia's position statement. VINCENT CORNELISSE: I would argue that for gay men, there is no population-level benefit for getting chlamydia rates down. DEMBOSKY: He says the consequences of syphilis can be dire - blindness, hearing loss, brain damage. Chlamydia, on the other hand, is more of a nuisance for men. He says doling out antibiotics to prevent it isn't worth it. CORNELISSE: I think we need to be a bit tempered in recommending strategies to reduce chlamydia, when the strategies themselves might have adverse outcomes. (SOUNDBITE OF POURING PILLS) DEMBOSKY: At the Strut clinic in San Francisco, Dr. Hyman Scott and his colleagues offer Doxy PEP to everyone they think could benefit - men, women, gay, straight. City officials updated local guidance to match this approach in May. (SOUNDBITE OF POURING PILLS) HYMAN SCOTT: We cannot make the same mistakes with rollout that we made with PrEP. DEMBOSKY: When the medication called PrEP came out to prevent HIV, Scott says officials placed a lot of restrictions on who should get it. It was so hard to access, and the guidelines were so confusing, by 2020, only a quarter of people in the U.S. who needed it were on it. SCOTT: There's a lot of things now that we're trying to undo, I think, as a result of the way we did it originally. DEMBOSKY: Scott says they want to reduce stigma. He reminds patients that antibiotics are already prescribed preventatively for Lyme disease and malaria. If the U.S. wants to reduce antibiotic use, he argues there's a better target. SCOTT: It's in actually the food and livestock industry. That's where we have the kilograms and kilograms of these antibiotics being used. DEMBOSKY: When it comes to the widespread offering of Doxy PEP, Scott says the benefits outweigh the concerns. For NPR News, I'm April Dembosky in San Francisco. Copyright © 2026 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information. Accuracy and availability of NPR transcripts may vary. Transcript text may be revised to correct errors or match updates to audio. Audio on npr.org may be edited af