Attitudes and prescribing practices on doxycycline postexposure prophylaxis (DoxyPEP) among Italian infectious diseases physicians: findings from a National SIMIT Survey

Objectives: Doxycycline postexposure prophylaxis (DoxyPEP) has emerged as a promising tool for reducing bacterial sexually transmitted infections (bSTIs), particularly among men who have sex with men. This study aims to investigate the attitudes and prescribing practices of Italian infectious disease (ID) physicians regarding DoxyPEP for the prevention of bSTIs. Methods: This is a cross-sectional survey conducted between October 2024 and March 2025 among ID specialists registered with the Italian Society of Infectious and Tropical Diseases. An anonymous online questionnaire assessed demographics, prescribing behaviour, attitudes and concerns regarding DoxyPEP. Favourability was rated on a visual analogue scale from 0 to 100. Descriptive and non-parametric statistics were used, and a Poisson regression model for predictors of favourable attitude was weighted according to the inverse of the probability of being sampled for responding to the survey. Results: Of 132 respondents, 44.0% reported prescribing DoxyPEP, primarily in STI or pre-exposure prophylaxis clinics and urban settings. Median favourability was 70/100 and was higher among DoxyPEP prescribers (80 vs 50, p<0.001). The main reasons for prescribing were repeated STIs and specific sexual behaviour. The most frequently cited concern was antimicrobial resistance (96.2%), followed by the perceived superiority of condoms in preventing bSTIs and DoxyPEP toxicity. Informal use of DoxyPEP without medical supervision was reported by 46.2%, but counselling was significantly lower among non-prescribers. Older age was independently associated with higher favourability (p=0.005). Conclusions: This national survey shows a favourable attitude towards DoxyPEP among Italian ID physicians. DoxyPEP prescription was reported by less than half of the respondents, suggesting limited real-world use in Italy, with a variability in physicians' concerns and attitudes towards this preventive strategy for bSTIs.