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Yeah, so it should be live now. And I can see we've got um a few people who've already joined, which is great. Um We'll probably give it a few more minutes and then kick off, just go on some time to log on after work. Oh, I think we've got a few more people that have joined. So, shall we kick off? Um So I'm Kate, I'm part of the staff steering committee and I'm gonna be kind of facilitating today. Uh And I'm gonna hand over to Caroline who's one of our fantastic um cig reps for the HPV CIG. Um And who'll be introducing our speaker? Um Absolutely. So, um Doctor Saunders has kindly agreed to give us this talk this evening. He is a consultant in genitourinary medicine and deputy head of program delivery and service improvement at the UK Health Security Agency. And he's the lead author for the Bash UK HSA position statement on the use of Doxycycline to prevent ST is and the forthcoming Bash Doxy Pep guideline. And uh I'll hand him over to you. Uh Are you over to him now to speak more about that? Thank you, Caroline. Thanks Kate. And thank you very much for inviting me to talk this evening. Let me just find uh the sharing thing. Uh Here we go. So hopefully now you can see the PDF of the slides and what I'm going to do uh this evening is give you an overview about what doxycycline prophylaxis. It s is really. And AQ and a later, we can kind of uh delve into some of the broader issues that this might raise in terms of uh antimicrobial resistance, antimicrobial stewardship, how it might be operationalized. Um Research questions, things that you'd like to know about really? So what will we cover? We'll go over uh a bit of the evidence base for the use of Doxycycline to prevent S TI S. So what do we currently know about it? Oops, sorry. Uh Secondly, how that evidence has been interpreted and uh used in position statements and in guidelines if they exist around the world. And then thirdly thinking about, well, what's gonna happen next with Doxycycline prophylaxis in the UK? How are we going to implement it? Um What does the kind of future for, for Doxy PB look like? So, acknowledging that you will have a range of um knowledge and experience about doxycycline and Doxy Pep. Uh and hopefully by the end of the talk, you'll know a lot more about it. But what I want you just to kind of ponder initially is what does your gut tell you about the use of Doxycycline, an antibiotic uh, to prevent ST, is, does that feel like it's a good thing to do? Does it feel like it's a bad thing to do? It's clearly probably not as binary as that and there's a lot more nuance to it. But, you know, listen to that voice inside you and think. Well, what is that telling you, uh, initially, what's your gut reaction about? Whether you think this is a good idea? And I don't think, or I can see the, the chat and you're welcome to kind of put into the chat whether you think. Yes, good idea. No bad idea. Maybe, um maybe you want to put some of your concerns or uh queries or um you know, uh you know, concerns or anxieties about what doxy pep um uh means to you or what you think it might mean uh for the future of ST medicine. So, uh thanks, you've already started it off and um I'll keep an eye on that and perhaps we'll come back to that and uh I'll pose this question at the end and see whether or not your position on that has, has changed at all. Really? So we are here in 2025 but the history of the use of antibiotics to prevent STIs s goes back 80 years or so. Ok. So if you look in the literature, you can find examples of studies that are using antibiotics to try and prevent STIs s and this is one of the very earliest of those. They all pretty much come from the US, military, uh, navy and army setting. So this is from, uh, a study that was conducted on the USS Houston. That is the USS USS at Houston. Um, and they use this antibiotic which, um, I certainly don't have any experience of and I expect none of you have experience of either called sulfathiazole. And they were using that to try and prevent uh the acquisition of gonorrhea and chancroid, chancroid is a, another ST I causes ulceration. You don't see much of it in the UK. In fact, we've only seen a couple of cases in the last 10 years. Um but it is more endemic in other areas of the co of the world. Uh And they did show a reduction in the acquisition of both of these infections. Uh And this is taken from the, the um the manuscript um in a discussion saying that they were, that the um participants, although they weren't really kind of recruited in the way that you would think of recruiting people into a study nowadays, uh were advised to use the condom. Hopefully they had access to more than one the next time that the er, they were exposed and given a little talk about venereal diseases in general. So, you know, trying to raise knowledge alongside the use of some biomedical uh intervention not long after. So, 1943. This is a study uh uh predominantly recruiting uh Black American uh GI S in Fort Benning. Um the use of sulfathiazole again for the for the prevention of gonorrhea. And they saw a very impressive drop in the incidence of gonorrhea uh using this approach. So in the intervention group, a level of eight infections per 1000 yearly compared to 100 and 71 per 1000 yearly in the control group. So the group that were not receiving any uh of the antibiotic. This is an example, uh using penicillin tablets to try and prevent gonorrhea, penicillin used to be very effective against gonorrhea. You may know that actually, um the there's a lot of resistance to penicillin in gonorrhea now and it's not something that we um uh would use first line now. Uh But they did show an uh again, an impressive reduction in the incidence of gonorrhea here, uh concerning, um and a kind of sign of the times in terms of um the kind of ethics of running clinical trials in the 19 forties. You can see here that the subjects were not told of the purpose of the study. And furthermore, they weren't told.