Does taking antibiotics after unprotected sex prevent HIV? 

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Raphael Obasiohia

What are antibiotics and their uses?

Conversations with some Nigerian youths have revealed a trending culture where antibiotics are taken for surprising reasons. For instance, some individuals believe that taking antibiotics before sex can delay ejaculation. 

Recently, a young man responded to my WhatsApp status, where I aimed to raise awareness of the consequences of the misuse of antibiotics. He admitted to using antibiotics as a means to delay ejaculation during masturbation: 

“Okay, teacher, me that has been using antibiotics to wank, that means I’m dead already… You never know o, once you’re wanking, you won’t cum fast,” he said. 

Similarly, there are supposed claims among women that antibiotics can prevent pregnancy or even induce abortion. However, this explainer focuses on another misconception: taking antibiotics after unprotected sex to prevent HIV. 

An X user, 604 (@catmoneyes), claimed that people take antibiotics for HIV prevention. This was in response to a post by Pharaoh (MrMekzy_) claiming:

“It’s the way a lot of young guys in Calabar use antibiotics as prophylactic measures against “infection” after having unprotected sex for me. What if she has a viral disease?…”

In another engagement on X, a user, Adeba (@nana_adeba), had replied to a post on antibiotics consumption after sex, admitting that he, amongst other men, takes antibiotics after unprotected sex. 

Another X user, Badman Jiggy Yo! (@Hozzin1), while replying to a post to campaign against indiscriminate intake of antibiotics, said: “I’ll take Ampiclox after sex..” This got over 1,000 views. 

Antibiotics are a class of medications used to treat bacterial infections by either killing bacteria or inhibiting their growth. They are commonly prescribed for various infections, including respiratory tract infections, urinary tract infections, skin infections, and sexually transmitted infections (STIs) caused by bacteria. 

Do antibiotics prevent HIV when taken after sex?

Post-sex antibiotic consumption as a purported preventive measure against HIV transmission has continued to gain acceptance amongst uninformed youths. This practice, though well-intentioned, carries inherent risks regarding individual health and the broader societal implications. 

With these misconceptions about antibiotics, several health specialists and other concerned persons have created awareness of the myths and facts of antibiotics in treating infections. An instance can be seen here, here, here, and here.

While some studies suggest that antibiotics, particularly doxycycline, taken shortly after sexual intercourse may reduce the risk of bacterial STIs, including chlamydia, syphilis, and gonorrhoea, among specific populations, their effectiveness in preventing HIV transmission is not well-established. 

HIV is a viral infection, and antibiotics are designed to target bacterial pathogens, making their efficacy against viral infections like HIV questionable. 

Moreover, the confusion between antibiotics and HIV prevention strategies disregards established preventive measures, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), which are specifically designed and rigorously tested for HIV prevention. PrEP, for instance, involves the daily administration of antiretroviral drugs to individuals at high risk of HIV exposure, offering a proven and effective means of prevention. 

Meanwhile, according to a publication by aids map, almost one in ten HIV PrEP users report buying antibiotics for STI prevention, raising concerns over potential antibiotic resistance.

Are there any health risks of post-sex antibiotic use?

The World Health Organisation (WHO) says that new data reveal a third of the population in 14 countries of the WHO European Region consumes antibiotics without a medical prescription. It further stated that in some countries, more than 40% of the antibiotics were obtained without medical advice.

Misuse of antibiotics, including taking them without a prescription or misusing them, can lead to adverse health outcomes. These risks include allergic reactions, side effects such as nausea and diarrhoea, and the development of antibiotic resistance. 

Antibiotic resistance occurs when bacteria adapt and become resistant to the effects of antibiotics, rendering the drugs ineffective in treating infections. This can lead to prolonged illness, increased healthcare costs, and in severe cases, treatment failure and death. Misusing antibiotics, such as taking them unnecessarily or not completing the prescribed course, contributes to the emergence of antibiotic-resistant bacteria.

What you must know about Antimicrobial Resistance (AMR)

Antimicrobial resistance (AMR) is a growing global health threat that compromises the effectiveness of antibiotics and other antimicrobial drugs. It can lead to increased morbidity and mortality, prolonged illness, and higher healthcare costs. The misuse and overuse of antibiotics contribute to the development of AMR, making infections harder to treat and threatening the achievements of modern medicine.

AMR affects individuals, communities, and healthcare systems worldwide. It poses challenges to infectious disease control, compromises patient outcomes, and undermines public health efforts. 

According to the World Health Organization (WHO), AMR is responsible for approximately 1.27 million deaths globally each year, with bacterial resistance contributing to nearly 5 million deaths. 

What do studies say?

Previous research studies have investigated the potential role of antibiotics, particularly doxycycline, in reducing the incidence of bacterial sexually transmitted infections (STIs) among high-risk populations, such as men who have sex with men (MSM). 

One notable study published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS) examined the efficacy of doxycycline post-exposure prophylaxis (PEP) in reducing the risk of bacterial STIs among MSM. The study found that participants who received doxycycline PEP experienced a lower incidence of bacterial STIs compared to those who did not receive the intervention. However, the study did not specifically assess the impact of doxycycline on HIV transmission, highlighting the need for further research in this area. 

Another study published in the New England Journal of Medicine (NEJM) by A.F. Luetkemeyer et al., evaluated the effectiveness of doxycycline PEP in preventing syphilis among MSM. The randomised controlled trial found that participants who received doxycycline had a significantly lower incidence of syphilis compared to those who received a placebo.

While the study demonstrated the efficacy of doxycycline in reducing the risk of contracting syphilis, its findings do not directly translate to HIV prevention, as syphilis and HIV are caused by different pathogens and may have distinct transmission dynamics. Despite these promising findings, concerns remain regarding the potential development of antimicrobial resistance (AMR) with widespread antibiotic use for STI prevention. 

A systematic review published in The Lancet Infectious Diseases examined the impact of doxycycline PEP on AMR among bacterial pathogens. The review concluded that while short-term use of doxycycline for STI prophylaxis is unlikely to result in significant AMR, long-term or indiscriminate use may contribute to the emergence of resistant bacteria, posing a public health risk. 

Meanwhile, further studies are needed to assess the efficacy, safety, and potential risks of post-sex antibiotic use for HIV prevention, taking into account the broader implications for antimicrobial resistance and public health.

What do experts say? 

Healthcare professionals and researchers emphasise the importance of evidence-based approaches to HIV prevention and STI management. 

In a joint chat, Dr Costa Atori, Senior Program Officer, USAID-funded Breakthrough ACTION Nigeria, and Dr Olayinka Badmus, Deputy Project Director of Risk Communication and Community Engagement, USAID-funded Breakthrough ACTION Nigeria, explained the critical distinction between bacterial infections and viral transmission in the context of HIV prevention. 

Dr Olayinka emphasised, “Using antibiotics as a preventive measure for a viral infection is wrong and should be discouraged as it is contributing to antimicrobial resistance.” 

Highlighting the ineffectiveness of antibiotics in preventing HIV transmission, Dr. Costa underscored the importance of antiretroviral medications such as Post Exposure Prophylaxis (PEP), asserting, 

“Antiviral post-exposure prophylaxis (PEP) must be taken correctly. It is also important to note that PEP is only commenced after the client has confirmed he/she is not HIV positive.”

In advocating for a comprehensive approach to STI control and antimicrobial resistance, Dr Olayinka stressed the importance of targeted treatment guided by microbial testing: “STI should be treated; however, treatment must be guided by the microorganisms identified. Meaning, test before you treat; and treat both partners.” 

She warned against the misuse of antibiotics, which can lead to distortion of normal flora in the vagina, treatment failure, protracted illness, risk of still contracting HIV, and the emergence of drug-resistant strains, complicating STI control efforts. 

Furthermore, Dr Costa and Dr Olayinka suggested alternative prevention methods such as safe sex practices, “Use a condom (male or female) every time you have sex,” couple counselling, and regular screening to reduce reliance on antibiotics. They emphasised the importance of ongoing training for healthcare professionals, provision of supportive materials, and implementation of antimicrobial stewardship programs to address the challenges of antimicrobial resistance.

In her research work titled, “Don’t Take Chances: Why Doxycycline is a Great Bet Against STIs,” Annie Luetkemeyer, a Professor of Infectious Diseases, Zuckerberg San Francisco General Hospital and UCSF, stressed, “Doxy-PEP does not protect against HIV or other viral infections, like herpes or the human papillomavirus (HPV), the virus that causes genital warts. If you think you have been exposed to HIV, you can take HIV post-exposure prophylaxis within three days to help reduce your risk of contracting HIV.”

Experts have recommended adherence to established guidelines for antibiotic use, including obtaining antibiotics only with a valid prescription, completing the prescribed course of treatment as directed, and avoiding antibiotics for non-bacterial infections or as a preventive measure without medical supervision.

Conclusion

While post-sex antibiotic use may offer some level of protection against bacterial STIs, its potential risks, including the development of antibiotic resistance, must be considered.

The researcher produced this explainer per the DUBAWA 2024 Kwame KariKari Fellowship, in partnership with Bridge Radio 98.7FM, Asaba, to facilitate the ethos of “truth” in journalism and enhance media literacy in the country.