Rates of all bacterial sexually transmitted infections in San Francisco were down by the end of 2024 compared to the previous year, according to the year-end STI report released by the health department on Valentine's Day.
A subject matter expert was not immediately available for comment February 14, but doctors have told the Bay Area Reporter in the past they think adoption of doxyPEP is making a positive impact.
DoxyPEP – a novel way of treating bacterial sexually transmitted infections with the antibiotic doxycycline (a type of tetracycline) after unprotected sex – has been approved for men who have sex with men and for trans women.
The report shows the total number of gonorrhea cases down from 4,988 at the end of 2023 to 4,799 at the end of 2024, though male rectal gonorrhea cases only are up from 1,585 to 1,696. This tracks with the doxyPEP hypothesis, though, as doxycycline has limited impact on gonorrhea.
"Gonorrhea has a real potential to develop [antibiotic] resistance, although doxycycline is not something we use for gonorrhea anymore because the cat is out of the bag there," Dr. Matt Spinelli, a UCSF assistant professor and medical lead of the PrEP clinic at Ward 86 told the B.A.R. for a report last year.
Looking at chlamydia, there were 4,214 reported cases at the end of 2024 in San Francisco compared with 5,622 at the end of 2023. Looking at male rectal cases only, 2024 had 827 cases compared with 1,434 at the end of 2023.
Total syphilis cases were down to 888 at the end of 2024 compared with 1,156 at the end of 2023. Cases of syphilis in cisgender women were down from 174 at the end of 2023 to 154 at the end of last year. Syphilis in women is a health priority as officials seek to prevent cases of congenital syphilis, of which there were only three cases in 2024 compared with six in 2023.
The report directly ties the declines to doxyPEP, citing a January 6 Journal of the American Medical Association study that linked declines in syphilis and chlamydia to the introduction of doxyPEP in San Francisco.
"However, despite the citywide decline in STIs, disparities persist," the report stated.
"There was a 11.5% decrease in syphilis cases among cis women from 2023 to 2024, less than half the decrease compared to men (the majority of whom were reported as gay, bisexual, or having had sex with other men)," the report stated. "People experiencing homelessness and people who use drugs also continue to be disproportionately affected by syphilis and congenital syphilis (CS). Encouraging in 2024 is that SF had 3 cases of congenital syphilis (CS), half as many cases as the year prior. Over the past year the Congenital Syphilis Taskforce developed a strategic plan identifying strategies the San Francisco Department of Public Health will employ over the next three years to move toward elimination of CS in SF."
The report found racial disparities, too.
"The 2024 STI data also show that Black/African Americans (B/AA) continue to be disproportionately affected by CT [chlamydia], GC [gonorrhea], and early syphilis," the report stated. "These racial disparities are even more notable when comparing B/AAs
There was one acute case of HIV (which is a virus, and not covered by doxyPEP protection) infection reported at City Clinic at the end of 2024, compared with three at the end of 2023. The total number of new HIV cases in 2023 in the city fell to 133 from 157 in 2022, under the leadership of AIDS expert Dr. Grant Colfax at the health department.
As the B.A.R. reported earlier this week, Mayor Daniel Lurie chose former Biden U.S. Centers for Medicare and Medicaid Services head Daniel Tsai as his new pick to lead the health department. Tsai is the first director of health who isn't gay or lesbian in over three decades.
City Clinic will be moving to an upgraded facility with the passage of Proposition B last November. As the B.A.R. reported last year, the current 91-year-old former firehouse on Sixth Street, in which the public health facility is currently located, is in a state of disrepair. Seventy-five percent of those served by the clinic are men who have sex with men and they rely on the sexual health services it provides.
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