I have written about the HIV prevention pill, PrEP, more than any journalist in the world. Truvada is not, in fact, particularly risky. One paper compared it favorably to aspirin. It is associated with a risk in lowered bone density and kidney function, but in HIV-negative people has never been associated with a fracture. 

And if quarterly screening tests indicate a decline in kidney function, people can just go off of it and their kidney function should rebound. People with pre-existing kidney or bone problems should avoid it. 

And that’s basically it. People obsess over and harp the potential risks of PrEP, real and imagined, because it is a way to displace the judgement they pass on gay men having sex with multiple partners without condoms. But PrEP has been on the market for 13 years, and in terms of health risks, nothing major has ever emerged.

That said, it is certainly likely that PrEP’s introduction and the impact it has had on gay sex patterns has played a role in the continued surge of STIs. 

DoxyPEP, or the use of doxycycline as post-exposure prophylaxis following sex, has already shown signs that it can help turn around the STI epidemic in gay men. There are potential risks. But initial signs are promising that it won’t cause a substantial shift in antimicrobial resistance.