Appropriate use of Doxy-PEP and inappropriate antibiotic self-medication for STI management: insights from a LGBTQIA+ survey in Italy

Background Doxycycline post-exposure prophylaxis (Doxy-PEP) has emerged as a promising strategy for preventing selected bacterial sexually transmitted infections (STIs). Nevertheless, concerns remain regarding unsupervised access and inappropriate antibiotic use, particularly in populations disproportionately affected by STIs. In Italy, evidence on real-life Doxy-PEP use and antibiotic self-medication for STI management is still limited. Methods We conducted a nationwide cross-sectional survey among LGBTQIA+ individuals in Italy to estimate the prevalence of Doxy-PEP use and antibiotic self-medication involving antibiotics other than doxycycline, and to identify associated determinants. Data were collected through an anonymous, online questionnaire disseminated via community-based channels. Results Among 211 respondents, 21.3% reported Doxy-PEP use, while 11.1% antibiotic self-medication for STI management. Doxy-PEP use was associated with HIV PrEP use (OR = 6.10; 95% CI: 1.09–34.24) and at least one STI diagnosis in the previous 12 months (OR = 6.33; 95% CI: 1.72–23.41), whereas it was inversely associated with antibiotic self-medication (OR = 0.04; 95% CI: 0.00–0.56). Antibiotic self-medication was associated with a history of prior STIs (OR = 4.82; 95% CI: 1.27–18.37) and younger age (OR = 0.93 for year; 95% CI: 0.86–0.99). A non-negligible proportion of Doxy-PEP users obtained doxycycline through informal or non-prescribed channels. Conclusions Two distinct patterns of antibiotic exposure coexist within the Italian LGBTQIA+ community: structured Doxy-PEP use embedded in prevention pathways and unsupervised antibiotic self-medication. Integrated strategies are needed to support appropriate Doxy-PEP implementation, reinforce antimicrobial stewardship, and reduce barriers to equitable sexual health care.