High Willingness to Use and Recommend Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention in Peru

Background – Bacterial sexually transmitted infections (STIs) remain prevalent among men who have sex with men (MSM) and transgender women (TGW) in Peru. Doxycycline postexposure prophylaxis (doxy-PEP) is a promising prevention strategy, but data from Latin America remain limited. Methods – We conducted 2 online surveys in Lima, Peru (September–October 2024). One assessed willingness to use doxy-PEP among MSM and TGW; the other assessed willingness to recommend doxy-PEP among health care providers (HCPs). Logistic regression evaluated correlates of high willingness. Results – Of 730 eligible MSM and TGW, 447 completed outcome measures. Overall, 82.1% expressed willingness to use doxy-PEP, 34.2% expressed high willingness. High willingness was associated with ≥5 anal sex partners in the past 3 months (adjusted odds ratio [aOR], 1.86; 95% confidence interval [CI], 1.06–3.24), prior HIV preexposure prophylaxis use (aOR, 2.56; 95% CI, 1.40–4.71), living with HIV (aOR, 2.74; 95% CI, 1.44–5.24), and concern about needing a prescription (aOR, 3.33; 95% CI, 1.99–5.66). Concerns about side effects (aOR, 0.55; 95% CI, 0.31–0.98) and microbiome disruption (aOR, 0.51; 95% CI, 0.29–0.87) were negatively associated. Most participants preferred doxy-PEP over daily doxycycline (64.0% vs. 28.6%). Among 132 HCPs, 54.5% were involved in HIV/STI care; 87.1% expressed willingness to recommend doxy-PEP, and 89.4% would do so if included in national guidelines. Limited diagnostic capacity and risk of unofficial use were most frequently endorsed concerns. Conclusions – High willingness to use or recommend doxy-PEP was observed among clients and HCPs in Peru, providing evidence to guide integration into sexual health services in Latin America.