Clinician awareness,attitudes and prescribing practices relating to doxycycline post-exposure prophylaxis (DoxyPEP) in Ireland: Cross-sectional survey of sexual health professionals

Abstract

Background

Doxycycline post-exposure prophylaxis (DoxyPEP) has emerged as a biomedical strategy to reduce bacterial sexually transmitted infections (STIs), yet implementation remains contested due to antimicrobial resistance concerns and limited clinical guidance in many European settings. Evidence on clinician readiness to prescribe DoxyPEP is limited. This study examined awareness, attitudes and prescribing practices among sexual health clinicians in the Republic of Ireland.

Methods

A cross-sectional anonymous online survey was conducted among sexual health clinicians in early 2026. Survey items were informed by the Theoretical Framework of Acceptability (TFA). Descriptive statistics summarised responses. Group differences were assessed using χ² tests, independent-samples t-tests, one-way ANOVA and non-parametric tests where appropriate. Pearson correlations explored relationships between implementation constructs.

Results

101 clinicians participated (60 doctors, 33 nurses, 8 other professionals). Awareness of DoxyPEP was high (95%) and 64% of doctors and nurses reported prior prescribing or recommendation. Current local guidance was variable, with only 28% reporting formal guidance, but willingness to prescribe with national guidance was high (82%) and did not differ between professional groups or specialties.

No significant differences were observed between doctors and nurses across knowledge or acceptability domains. Among doctors, implementation perceptions varied by specialty: GU/HIV clinicians reported higher knowledge, perceived effectiveness, intervention coherence and self-efficacy than infectious diseases clinicians and general practitioners.

Self-reported knowledge was strongly associated with intervention coherence (r = −0.601, p < .001) and self-efficacy (r = 0.600, p < .001). Ethicality emerged as the only independent predictor of willingness to prescribe (OR = 5.77, 95% CI 2.47–13.47). Concern about antimicrobial resistance was widespread (81%).

Conclusion

Irish clinicians demonstrate high awareness and substantial readiness to prescribe DoxyPEP. Implementation readiness appears shaped more by ethical acceptability and professional confidence than knowledge alone. National guidance, education and antimicrobial stewardship frameworks will be essential to support safe and equitable integration of DoxyPEP into sexual health services.