City Expanded Doxy-PEP Eligibility in May
The city updated its guidance to allow access for cisgender women and others assigned female at birth.
Updated on Oct. 14, 2026 in Sexual Health
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San Francisco health officials widened access to the preventative antibiotic doxy-PEP this past May to include cisgender women and anyone assigned female at birth. The policy shift follows the city's 2025 health data showing decreases in common bacterial infections.
Why it matters
The change aims to broaden the use of post-exposure prophylaxis as a tool for preventing STIs, including congenital syphilis. Officials based the decision on medical studies from Japan and Kenya that suggest doxycycline can effectively prevent infections in cisgender women.
San Francisco recorded a 24% drop in syphilis, 18% in chlamydia, and 5% in gonorrhea cases in 2025 compared to 2024. The long-term effectiveness of the drug for the newly eligible population remains under investigation.
The players
San Francisco Department of Public Health
The agency responsible for managing citywide health guidance and disease prevention policies.
The details
Under the updated guidance, clinicians are now permitted to offer a 200-milligram dose of doxycycline to cisgender women who meet specific risk criteria. Eligibility is determined through a shared decision-making process between patient and doctor to assess individual risk. This marks an expansion from the original October 2022 guidance, which remains limited at the federal level to men who have sex with men and transgender women.
Timeline
October 2022: San Francisco issued the nation's first doxy-PEP guidance.
2024: This served as the baseline year for city infection rate comparisons.
2025: The city recorded drops in syphilis, chlamydia, and gonorrhea.
May 2026: San Francisco officially updated its doxy-PEP health guidance.
Across the Bay
San Francisco's updated guidance marks a departure from the CDC's doxy-PEP clinical guidelines, which currently limit recommendations to men who have sex with men and transgender women. The city's move expands access to patient groups not explicitly covered by the federal framework.
If you are a patient eligible under the new risk assessment criteria, you can now discuss doxycycline prophylaxis with your healthcare provider during your next visit. Eligibility for the 200-milligram dose is decided individually through a clinical assessment of your risk factors.
The takeaway
San Francisco now allows clinicians to prescribe doxy-PEP to a broader range of patients based on individual risk assessments rather than strict demographic categories. Residents should consult their primary care provider to determine if the 200-milligram post-exposure dose is appropriate for their needs.
Further reading
For more information on local preventive care programs, visit the Sexual Health page.
Source note: This article includes information reported by Medical Daily.
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