Brian Moynihan, CEO of Bank of America, leaves the U.S. Capitol after a meeting with Republican members of the Senate Banking, Housing and Urban Affairs Committee on the issue of debanking on Thursday, February 13, 2025.
Tom Williams | Cq-roll Call, Inc. | Getty Images
Bank of America is scheduled to report second-quarter earnings before the opening bell Wednesday.
Here’s what Wall Street expects:
Earnings: 86 cents per share, according to LSEG
Revenue: $26.72 billion, according to LSEG
Net Interest Income: $14.89 billion, according to StreetAccount
Trading: Fixed income of $3.14 billion, equities of $2.14 billion, according to StreetAccount
Bank of America is likely to have benefited from two tailwinds during the quarter.
Analysts expect net interest income, which is the difference in what banks pay depositors and what they earn on loans and investments, to have risen in the period.
That could be an inflection point of sorts, with NII rising in the second half of this year, according to Truist analyst John McDonald.
On top of that, analysts expect trading revenues to climb in the “mid to high single digits” to about $5 billion in the quarter, McDonald said.
Meanwhile, the company gave guidance of a roughly 23% decline in investment banking fees in the quarter, but rival bank JPMorgan Chase saw a rebound in activity that bodes well for Bank of America.
Shares of the bank have climbed roughly 5% this year.
On Tuesday, JPMorgan, Citigroup and Wells Fargo each posted results that topped analysts’ expectations for earnings and revenue.
This story is developing. Please check back for updates.
Interloop, one of Pakistan’s largest denim, apparel and underwear manufacturers has had its sustainable cotton sourcing programme certified by Regenagri from Control Union.
Launched in 2024, Interloop’s Regen Kapas programme spans 25 villages across southern Punjab, partnering with 1,000 farmers and covering more than 6,000 acres of cotton growing land.
Some of us are utterly hopeless with admin, others so good they do it for a living. What are the best ways to get your working life under control? Administrators share their productivity tips and efficiency hacks.
Plan your day …
“First thing in the morning, I spend half an hour going through emails and making a plan for the day,” says Claudine Hopgood, an administrator for the heads of product planning and network sales at Volkswagen Group UK in Milton Keynes. “You can never schedule 100% of your day; I schedule 80%, and the other 20% is to allow for unforeseen interruptions.”
Start the day with a plan. Photograph: Posed by model; Maria Korneeva/Getty Images
… and your week
“Have a good overview of your week,” says Suzanne Ekpenyong, the lead virtual assistant of an agency of VAs that she runs from Woodford, east London. “Check your availability and whether it works for you. Do you have enough desk time? Are you travelling too much? Does it work around your personal life? What is your energy going to be like that week? I think everybody should get into the habit of looking at their diary from an energy perspective and seeing if there is enough balance there.”
Get the most difficult task out of the way first
“I eat the frog first,” says Hopgood, referring to motivational speaker Brian Tracy’s theory that you should start the day with your most tedious task to get it out of the way. “Procrastination is king. If you continually put off the three tasks you have to get done, you know they’re not going to get done. So get them done first and get the dopamine hit afterward.”
Maximise your calendar notifications
“Make sure you have notifications set up on your diary system,” says Ekpenyong. “Google or Outlook might give a notification 15 minutes before something starts but, when you set up the meeting or appointment, it is useful to put in a notification three days before, two days before, and so on, so that you’re on top of your preparation. This helps you to not stress at the last minute.”
Craig Bryson agrees. The executive assistant at a private equity company in Mayfair, who hosts a podcast for administrators, says: “I use my mobile calendar to remember birthdays and anniversaries – I have 46 cousins, so I need to be on top of that. I always hear the comment, ‘Oh, you’re a man – are you able to multitask?’”
Abide by the four Ds
“This is great for culling your inbox,” says Ekpenyong. The Ds stand for do, defer, delegate and delete. “Do what you need to do in the moment; defer it until later, so it might go on your to-do list at that point; delegate it to someone else – that’s amazing because then they can crack on with it; and the most wonderful thing is deleting things that you don’t need, you’ve already done, that are no longer relevant – they can go straight in the bin.”
Aspire to inbox zero – but don’t obsess
“I’m motivated by the challenge and excitement of thinking, ‘Today’s the day I’ll reach inbox zero’,” says Bryson. “I never do, but I think it’s about the passion of trying.”
“Inbox zero is just the best way of working,” says Jess Branch from St Albans, personal assistant to Simon Allford, architect and co-founder of Allford Hall Monaghan Morris. “Especially working with my jobshare, Georgia. We use it as a very clear gauge when we are trying to work out our workload. We categorise all our emails: red is an email that needs to be actioned, green is an email that is waiting on a reply. So it is basically using your inbox as a to-do list and just constantly trying to get it down so you feel ahead of the game.”
Have a priority to-do list
“I’m a big list-maker,” says Ekpenyong. “I use the Asana app, a project- and task-management system. But sometimes it is quicker just to grab a pen and pad and write down your three top priorities because sometimes, when you’re really busy, it’s really easy to think, ‘I can’t cope.’ That is why I swear by a ‘must-do’ list, which is different from my to-do list. These are the things you know are very critical and must absolutely happen that day. Anything else is a bonus.”
She also recommends keeping a “ta-da list” of everything you have completed: “It gives you a great sense of achievement, which is often what you need to keep going with the rest of your to-do.”
Always make notes
“The Notes app on my phone is my saviour,” says Shanice Robertson, a virtual assistant based in Aberdeen. “I’ve tried a few apps but honestly, between my notebook and the Notes app on my phone, I think old-school is the best way.”
Hopgood adds: “I have a 3am brain-dump notebook by the bed of just random things.” At work, she has a pen on her lanyard for “when you’re on the fly, you’re going to a meeting and somebody stops you. I’ve always got a small notebook with me that fits in my pocket so I can quickly scribble something down.”
“Always write it down,” agrees Bryson. When the executive he works for calls him in, he grabs a pad, “because, by the time you get back to your desk, you’ve probably forgotten exactly what you got asked to do that is important. Your brain is more for ideas and not storage.”
Find ways for AI to help you
“I use AI to tell me to do stuff,” says Branch. “When I make my packed lunch for the next day, I will say, ‘Alexa, set an alarm for 7.20am for me to take my lunch out of the fridge.’ So while I’m running around, getting my girls out of the house, Alexa will say, ‘Don’t forget to take your lunch.’ Sometimes, I will go to [Microsoft’s AI assistant] Copilot, and say, ‘I need to write an email. It needs to include this, this and this. How should I do it?’ And I’ll just put the facts in, and then it will write an eloquent email that would have taken me 10 minutes.”
“If you are feeling overwhelmed,” says Robertson, “you couldput into ChatGPT, ‘Tomorrow, I’ve got to do this; can you work out a plan for me? Break it down into 15-minute goals’, and then you’ll feel better about the next day.”
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“Copilot and ChatGPT are massive time-saving tools,” says Hopgood. “You can enter a report and ask for a PowerPoint of 80 slides. You can put a document in and, within seconds, you have a really accurate summary that would have taken you two hours. I joke to my boss, ‘You won’t need me any more.’ But we will still need people. It’s about using AI to your advantage.”
Pick up the phone
“Sometimes I’d rather stick pins in my eyes than fill out another Doodle poll [to agree a time for a meeting],” says Branch. “If I’m dealing with PAs in other companies, it is much easier to just pick up the phone.”
Alternatively, send a voice note, says Robertson: “If I’m in the middle of a task and I remember I need to tell a client something, I’ll just quickly do a voice note – you can work away while it’s recording.”
Give yourself five seconds to stop procrastinating
Robertson is a fan of the American author Mel Robbins’ five-second rule: “She was lying in bed and she’d seen a rocket on TV the night before, shooting into space, so thought, ‘I’m going to count down 54321 and then launch myself like a rocket.’
“If I find I’m scrolling on my phone, or if I’m thinking about doing a task, I say to myself ‘54321’ and I just do it.”
Try putting your phone away. Photograph: Posed by model; elenaleonova/Getty Images
If you need to get something done, hide
“I love being distracted,” says Hopgood, “so I do this thing called ‘tactical hiding’ where, if I have something that needs to be done, I will leave my desk. I tell one person where I’m going. I go offline, and I put my phone away. There is a really good app called Forest and, if you have a job, you put in an hour and it grows [virtual] trees. If you pick up your phone and go on to Instagram or something, all your trees die. At the end of the week, you can see how many trees you’ve grown.”
Own up to mistakes
Inevitably, even the most organised people sometimes forget things and the admin assistants all agree you have to have some perspective on this. “If you put the wrong link in an email, is somebody still going to be talking about that five years later? No,” says Branch. “Sometimes things do go wrong, and that’s fine, because I’m not perfect.”
“Own up to mistakes,” says Hopgood. “Just put your hands up and say, ‘I messed up. I forgot to do that. This is what I’ve done to put it right.’ But just own your mistake. There’s no point trying to cover it up, because you will always be found out.”
“There is no such thing as perfection,” says Bryson. “When we make mistakes, we have to think, ‘I will never do it again, because I remember the feeling from that mistake.’ We learn from them, which is a great thing.”
Learn when to switch off
“When I go on holiday, I delete Teams from my phone,” says Branch. “There is no reason for me to know anything. I care about my job very passionately, but it isn’t life or death.”During the working day, she says, “make sure you’re standing up and moving around, taking a trip to the photocopier or whatever, and taking breaks. Sometimes, if you have loads and loads to do, it feels like the thing you should do is sit at your desk until it’s done. But you need to have a lunch break, and you’ll be so much more productive when you come back.”
“You just have to switch off,” says Bryson. “I’ve heard of people taking a month off work as a result of burnout, because they always reach for their mobile just to see whether there are any messages at 8pm. I have a family and a life I want to be able to focus on. You have to create boundaries to help protect your mental health.”
Here is our weekly summary of key legal and regulatory developments relevant to occupational pension schemes that you might have missed, with links for further information.
The chancellor’s Mansion House speech on 15 July 2025 did not contain any pensions surprises. She referenced the creation of defined contribution (DC) and Local Government Pension Scheme mega funds, the recent Mansion House Accord, and a new employer pledge to prioritise value before cost when selecting or reviewing DC pension providers. The chancellor did say that the Pension Schemes Bill will be “signed into law in the next few months”, but this seems unlikely given that the bill is still in the early stages of being considered by Parliament and is not scheduled to start its line-by-line examination by the public bill committee until 2 September. Several documents were published to supplement the speech, including the government’s outcome of its call for evidence on a financial services growth and competitiveness strategy. The outcome notes that various sustainability initiatives, along with measures to encourage the public to invest in UK equities, will be progressed. Meanwhile, one proposal that is not being taken forward is the UK green taxonomy, which had been proposed as a means of mitigating against greenwashing. There was no mention of the forthcoming pensions adequacy review in the chancellor’s speech, although it is possible (but perhaps unlikely now) that it will appear as an additional paper soon.
As mentioned in a previous update, the Financial Conduct Authority (FCA) is running a consultation on addressing the “advice gap”. Some of the questions in the consultation are addressed to occupational pension trustees, to assess their views on providing more support to members, how this could be delivered and barriers to delivery. The consultation runs until 29 August 2025. Connected with this, the government has issued a policy document and draft legislation on the provision of “targeted support”, as part of its Mansion House package. Firms regulated by the FCA or Prudential Regulation Authority (PRA) will be able to provide support to groups of customers, based on their characteristics. Firms will need special authorisation to provide targeted support.
The Pensions Administration Standards Association (PASA) has updated its dashboards Data Matching Convention (DMC) Guidance. This is described as an “evolving document”, which will be further informed by industry experience, consumer testing and live dashboards usage. The latest update includes refinements following last year’s confirmation that the government’s One Login service will be used for identity verification, which impacts the verified data in a “find request.” Other updates focus on the use of unique identifiers (such as email addresses), acceptable levels of certainty for a “match made” and the need to make sure that possible matches are well targeted, to avoid the system being flooded with false responses “which would be bad for saver experience and administrator workload”.
The Pensions Dashboards programme has reported that over 20 million pension records are now connected to the dashboards ecosystem and the state pension has also completed its technical connection. Separately, plans for consumer testing of the MoneyHelper dashboard have been published. Testing will begin with pensions industry experts before involving the general public.
The Pension Protection Fund (PPF) has published its annual report and accounts for 2024-2025. It notes a fall in both asset values and liabilities, but also that there has been a £1.1 billion increase overall in reserves to £14.1 billion. The report and accounts confirm that the PPF has completed implementation of the Hampshire uplifts (which ensure that members’ PPF compensation is at least 50% of the value of their accrued scheme benefits) and the removal of the PPF compensation cap for all eligible members. The current levy estimate of £45 million for 2025-2026 is under review in light of legislation contained in the Pension Schemes Bill.
Our labour and employment colleagues have updated their publication on the Employment Rights Bill to reflect the latest developments.
If you would like specific advice on any of these issues or anything else, please contact a member of our Pensions team.
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Can you imagine a life-saving molecule whose “twin” is a deadly poison? As surprising as it may seem, this chemical reality is known as “chirality”. Like a right hand and a left hand, two molecules can have the same composition, but a different shape and arrangement in space. And this difference can change everything. Understanding and controlling this phenomenon is crucial to drug design. A team from the University of Geneva (UNIGE), in collaboration with the University of Pisa, has developed a new family of remarkably stable chiral molecules. This work opens up new prospects for the design of geometry-controlled drugs. It is published in the Journal of the American Chemical Society.
A molecule, or any object, is said to be chiral if it cannot be superimposed on its mirror image by any combination of rotations, translations and geometric changes. This is similar to our two hands, which appear identical but cannot be superimposed, whether viewed from the back or the palm. This universal molecular asymmetry requires chemists to design chiral molecules capable of interacting precisely with living systems.
This new way of organizing molecular space opens up a whole new degree of freedom and imagination in chemical synthesis.
Within a molecule, chirality often arises from the presence of one or more asymmetry centers, known as stereogenic centers. These are often made up of a central carbon atom, itself linked to four different groups or chains of atoms, usually carbon as well. The group led by Jérôme Lacour, Full Professor in the Department of Organic Chemistry, School of Chemistry and Biochemistry, UNIGE Faculty of Science, has created a new type of stereogenic center. This time, the central carbon atom is not surrounded by carbon chains, but only by oxygen and nitrogen atoms. A first in the field of chemistry.
‘‘Molecules with this new type of stereogenic center had never before been isolated in a stable form. Their synthesis and characterization mark a major conceptual and experimental breakthrough,’’ explains Jérôme Lacour.
Outstanding stability
The stability of chiral molecules is a particularly important parameter. Mirror molecule pairs are structurally very close, and in many cases spontaneous switching from one to the other is possible, for example under the effect of temperature. As if a left hand were suddenly transformed into a right hand. In this way, we could switch from a drug to an inactive or even toxic molecule! The new molecular structures developed by the UNIGE team feature exceptional chiral stability, meaning that the switch from one molecule to its mirror sister is particularly unlikely.
Olivier Viudes, PhD student and first author of the study explains: “Using dynamic chromatography techniques and quantum chemistry calculations, we have shown that, for the first molecule developed, it would take 84,000 years at room temperature for half a sample to transform into its mirror molecule”. For a drug, such stability guarantees safe storage, without the need for specific conditions. For the second molecule, this time has been estimated at 227 days at 25°C.
The new stereogenic centers developed by the Geneva team should enable the design of stable, controlled, three-dimensional chiral molecules. These structures open up new possibilities for drug design and the creation of new materials. ‘‘These novel stereogenic centers offer a new way of organizing molecular space. They open up a whole new degree of freedom and imagination in chemical synthesis,’’ concludes Gennaro Pescitelli, professor at the University of Pisa and co-principal investigator of the article.
Reference: Viudes O, Besnard C, Siegle AF, et al. All-heteroatom-substituted carbon spiro stereocenters: synthesis, resolution, enantiomeric stability, and absolute configuration. J Am Chem Soc. 2025;147(24):21121-21130. doi: 10.1021/jacs.5c06394
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On 16 July 2000, the members of Real Madrid elected Florentino Pérez as president of our club. Under his mandate, Real Madrid has won 66 titles: 37 in football (7 European Cups, 7 Club World Cups, 6 European Super Cups, 7 LaLiga titles, 3 King’s Cups and 7 Spanish Super Cups) and 29 in basketball (3 European Cups, 1 Intercontinental Cup, 9 LaLigas, 7 King’s Cups and 9 Spanish Super Cups).
Florentino Pérez has carried out a profound transformation in all the structures of Real Madrid, making it ‘the most valuable sports club in the world’, according to the prestigious publication Forbes. In his two decades as president, our club has undergone a process of modernisation with the construction of Real Madrid City and the remodelling of the Santiago Bernabéu to transform it into an avant-garde icon, featuring maximum comfort, security, and state-of-the-art technology. Under his mandate, Real Madrid is experiencing one of the most spectacular winning cycles in its 123-year history and is the only club to have won 6 European Cups in the last 11 years.
Infosys (NSE, BSE, NYSE: INFY), a global leader in next-generation digital services and consulting, today announced the launch of the Infosys Enterprise Innovation Lab for SAP Solutions at Infosys’ premises in Düsseldorf, Germany. As part of the collaboration between Infosys and SAP, this lab is designed to enable enterprises to explore the limitless possibilities of AI and data, co-create tailored solutions that address their business challenges, and accelerate the adoption of cutting-edge Infosys and SAP offerings. Leveraging SAP Business AI, the SAP Business Data Cloud solution, and the RISE with SAP journey, along with Infosys Cobalt, a set of services, solutions and platforms for enterprises to help accelerate their cloud journey, and Infosys Topaz, an AI-first offering using generative AI technologies, the collaboration aims to help businesses inspire, ideate, prototype, and leapfrog their AI, cloud, and digital journeys.
Working closely with SAP, Infosys is revolutionizing the approach for business transformation by offering a collaborative and informative workspace where organizations can ideate on integrating enterprise-wide data to fuel AI-based solutions. This lab will help enable organizations to envision solutions to help improve financial performance, enhance operational efficiency, risk mitigation, decision-making facilitated by real-time data insights, and elevate compliance and security. Solutions from the Enterprise Innovation Lab in Dusseldorf will also be available across Infosys’ global network of over 12 Living Labs.
Key highlights of the Infosys Enterprise Innovation Lab for SAP Solutions:
Tangible Experience: Offers access to Infosys Topaz and SAP Business AI to discover possibilities and develop practical applications.
Co-creation and Innovate Provides a collaborative space for customers and experts to co-create AI solutions tailored to specific business needs.
Strategy Development: Creates a foundation for designing AI and data strategies that achieve business goals through clear plans and use cases.
Data-driven Architecture: Helps combine enterprise-wide data using SAP Business Data Cloud to unlock its full potential.
Rapid Prototyping and Scaling: Enables fast-tracking of prototype creation and transform them into scalable and fully integrated AI and data solutions.
Thomas Saueressig, Member of the Executive Board of SAP SE, Customer Services & Delivery, said, “In today’s fast-changing world, staying ahead requires faster, more flexible transformations with lasting value. With AI-powered innovation and seamless cloud adoption, businesses can shift from reactive to proactive strategies. Thus, we are delighted to collaborate with Infosys on the Enterprise Innovation Lab, embodying our shared commitment to empowering businesses with pioneering AI & Data solutions. Having received the RISE with SAP Validated Partner recognition, Infosys leverages its profound expertise in cloud transformations, empowering our joint customers to seize new opportunities and foster innovation by strategically integrating SAP solutions.”
Dinesh Rao, EVP – Chief Delivery Officer, Infosys, said, “Enterprises seeking to embrace new SAP solutions can significantly accelerate their transformation journey by overcoming adoption and integration hurdles. The Infosys Enterprise Innovation Lab for SAP Solutions at our Düsseldorf office provides a collaborative space to develop tailored solutions. By harnessing the capabilities of Infosys Topaz and Infosys Cobalt, we aim to empower businesses to leverage the full potential of cloud, data, and AI and benefit from tangible business outcomes such as enhanced efficiency, improved decision-making, significant cost savings, and future-readiness.”
With over 25 years of expertise in SAP software transformation, consulting, technology, and a comprehensive suite of tools and accelerators, Infosys is collaborating with SAP to develop cloud and AI solutions across industries. Building on this strong foundation, the lab will help accelerate business transformation by enabling organizations to harness the full potential of emerging technologies and stay ahead in a rapidly evolving business landscape.
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About Infosys
Infosys is a global leader in next-generation digital services and consulting. Over 320,000 of our people work to amplify human potential and create the next opportunity for people, businesses, and communities. We enable clients in more than 59 countries to navigate their digital transformation. With over four decades of experience in managing the systems and workings of global enterprises, we expertly steer clients, as they navigate their digital transformation powered by cloud and AI. We enable them with an AI-first core, empower the business with agile digital at scale and drive continuous improvement with always-on learning through the transfer of digital skills, expertise, and ideas from our innovation ecosystem. We are deeply committed to being a well-governed, environmentally sustainable organization where diverse talent thrives in an inclusive workplace.
Visit www.infosys.com to see how Infosys (NSE, BSE, NYSE: INFY) can help your enterprise navigate your next.
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Certain statements in this release concerning our future growth prospects, or our future financial or operating performance, are forward-looking statements intended to qualify for the ‘safe harbor’ under the Private Securities Litigation Reform Act of 1995, which involve a number of risks and uncertainties that could cause actual results or outcomes to differ materially from those in such forward-looking statements. The risks and uncertainties relating to these statements include, but are not limited to, risks and uncertainties regarding the execution of our business strategy, increased competition for talent, our ability to attract and retain personnel, increase in wages, investments to reskill our employees, our ability to effectively implement a hybrid work model, economic uncertainties and geo-political situations, technological disruptions and innovations such as artificial intelligence (“AI”), generative AI, the complex and evolving regulatory landscape including immigration regulation changes, our ESG vision, our capital allocation policy and expectations concerning our market position, future operations, margins, profitability, liquidity, capital resources, our corporate actions including acquisitions, and cybersecurity matters. Important factors that may cause actual results or outcomes to differ from those implied by the forward-looking statements are discussed in more detail in our US Securities and Exchange Commission filings including our Annual Report on Form 20-F for the fiscal year ended March 31, 2025. These filings are available at www.sec.gov. Infosys may, from time to time, make additional written and oral forward-looking statements, including statements contained in the Company’s filings with the Securities and Exchange Commission and our reports to shareholders. The Company does not undertake to update any forward-looking statements that may be made from time to time by or on behalf of the Company unless it is required by law.
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As doxycycline post-exposure prophylaxis (doxyPEP) for prevention of sexually transmitted infections (STIs) enters widespread use, questions remain about its implementation in the real world. At a symposium yesterday at the 13th International AIDS Society Conference on HIV Science (IAS 2025), experts discussed outstanding challenges, including increasing antibiotic resistance.
DoxyPEP involves taking a 200mg dose of the antibiotic doxycycline within 72 hours after sex. As reported in 2022, a study of men who have sex with men and transgender women in San Francisco and Seattle showed that doxyPEP significantly reduced the risk of chlamydia, syphilis and gonorrhoea. However, doxyPEP was less effective against gonorrhoea in French trials, likely because the background level of drug resistance is higher. A study of young cisgender women in Kenya found that doxyPEP was not effective, largely due to inconsistent use.
At the IAS conference, Professor Annie Luetkemeyer of the University of California San Francisco, who co-led the San Francisco and Seattle trial, offered practical advice for addressing clinical challenges in doxyPEP delivery. Professor Elizabeth Bukusi of the Kenya Medical Research Institute, a principal investigator for the dPEP Kenya trial, discussed implementing doxyPEP for cisgender women. Professor Jean-Michel Molina of Hôpital St Louis in Paris, who has led multiple STI and HIV prevention trials, discussed how to move forward with doxyPEP in the face of antimicrobial resistance – which moderator Dr Troy Grennan of the British Columbia Centre for Disease Control called “the elephant in the room.”
Glossary
chlamydia
Chlamydia is a common sexually transmitted infection, caused by bacteria called Chlamydia trachomatis. Women can get chlamydia in the cervix, rectum, or throat. Men can get chlamydia in the urethra (inside the penis), rectum, or throat. Chlamydia is treated with antibiotics.
antibiotics
Antibiotics, also known as antibacterials, are medications that destroy or slow down the growth of bacteria. They are used to treat diseases caused by bacteria.
cisgender (cis)
A person whose gender identity and expression matches the biological sex they were assigned when they were born. A cisgender person is not transgender.
syphilis
A sexually transmitted infection caused by the bacterium Treponema pallidum. Transmission can occur by direct contact with a syphilis sore during vaginal, anal, or oral sex. Sores may be found around the penis, vagina, or anus, or in the rectum, on the lips, or in the mouth, but syphilis is often asymptomatic. It can spread from an infected mother to her unborn baby.
drug resistance
A drug-resistant HIV strain is one which is less susceptible to the effects of one or more anti-HIV drugs because of an accumulation of HIV mutations in its genotype. Resistance can be the result of a poor adherence to treatment or of transmission of an already resistant virus.
Since these trial results were reported, several cities and countries have issued doxyPEP guidelines, Luetkemeyer noted. San Francisco, which released the first guidance in 2022, gives a broad recommendation that goes beyond the populations included in clinical trials. These guidelines include people who have condomless sex with at least one partner but have not had an STI in the past year, because “we don’t want to wait until the horse is out of barn,” she said. “If you try to restrict doxyPEP only to certain populations at the very highest risk, you’re going to avert less STIs.”
More recent guidance from Australia is more cautious. The British Association for Sexual Health and HIV (BASHH) issued the first UK doxyPEP guidelines last month, emphasising syphilis prevention. Belgium and the Netherlands, among others, do not recommend doxyPEP for STI prevention, although many Dutch men in a recent survey reported informal use.
The main reason for caution is that widespread use of doxycycline for PEP – or daily use for pre-exposure prophylaxis (doxyPrEP) – could promote antibiotic resistance. This is primarily a concern for gonorrhoea, which is often already resistant to tetracyclines (the drug class that includes doxycycline) and most other drugs once used to treat it. What’s more, Neisseria gonorrhoeae can potentially transfer tetracycline resistance genes to other species of bacteria. Tetracycline resistance is not a concern for chlamydia or syphilis.
An early analysis from the San Francisco and Seattle trial did not show a marked increase in antimicrobial resistance associated with doxyPEP use. Presenting the results in 2023, Luetkemeyer called the findings “reassuring,” but said that larger and longer studies were needed.
As doxyPEP use has risen, these concerns about resistance have been confirmed. The week before the conference, a report in The New England Journal of Medicine showed that extensively drug-resistant gonorrhoea is spreading.
Dr David Helekal of the Harvard T.H. Chan School of Public Health and colleagues analysed more than 14,000 N. gonorrhoeae genome sequences from 2018 to 2024, generated through the US Centers for Disease Control and Prevention surveillance system.
They found that the proportion of isolates carrying tetM, a gene conferring high-level resistance to tetracyclines, rose from less than 10% in 2020 to over 30% in the first quarter of 2024. Furthermore, the number of N. gonorrhoeae lineages carrying the gene rose from one to four. Concerningly, two of these lineages also carried mutations that reduce sensitivity to ceftriaxone, one of the only remaining effective drugs.
The increase coincided with a shift away from azithromycin toward doxycycline for chlamydia treatment and also growing use of doxyPEP. “These results suggest that widespread use of doxycycline for the treatment and prevention of sexually transmitted infections may be contributing to reshaping of the gonococcal population in the United States,” the researchers wrote.
The prevalence of drug resistance varied by region in the US, being highest in the northwest – which includes Seattle, an early adopter of doxyPEP. A previous report from the city found that high-level tetracycline resistance among gay men with gonorrhoea rose from 2% in early 2021 to 65% by the end of 2024. Specifically, taking more than three doses of doxyPEP per month was associated with having both overall and high-level resistance. In addition, tetracycline-resistant Staphylococcus aureus and group A Streptococcus were more common among doxyPEP users compared with non-users.
Gonorrhoea resistance rates are even higher in other parts of the world. A recent systematic review and meta-analysis published in JAC-Antimicrobial Resistance, which included studies done before the advent of doxyPEP, found that the prevalence of tetracycline-resistant N gonorrhoeae ranged from 27% in North America to about 50% in Europe to more than 80% in sub-Saharan Africa and east Asia.
Molina recalled that in the DoxyVAC trial, gonorrhoea isolates with high-level tetracycline resistance were threefold more common among doxyPEP users compared with non-users. All strains remained susceptible to ceftriaxone, though reduced sensitivity to cefixime (another cephalosporin antibiotic) increased among doxyPEP users.
“Clearly, doxyPEP is well tolerated. It’s highly accessible and very cheap. But there are still long-term uncertainties which need to be addressed in the future. We need to continue to monitor antimicrobial resistance,” he said. “I think we can do better, but it is time to implement doxyPEP in people at risk. We need to be cautious. It’s not for everyone. I think it would be wise to limit the number of doses of doxyPEP per week…one to two dose per week seems to be reasonable.”
Bukusi stressed that young women in Africa are at very high risk for STIs and their complications, including pelvic inflammatory disease and infertility, largely driven by chlamydia. Her team is winding up a study of whether doxyPEP works for cisgender women if taken consistently, which did not happen in the dPEP trial in part due to disruptions at the start of the COVID pandemic. They are exploring directly observed therapy – an approach widely used for tuberculosis treatment – at a clinic, another safe place or via telemedicine.
As for whether we can currently recommend doxyPEP as an STI prevention tool for cisgender women, “We don’t have answers yet, and these answers seem to be very difficult to come by. However, when we delay guidelines, there are real consequences for women,” she said. “It is not just about clinicians being able to have the power to make decisions, it is about talking to these young women and finding out what works for them.”
The experts agreed that while doxyPEP is an effective intervention for preventing chlamydia and syphilis, it will be challenging to use antimicrobial approaches for gonorrhoea due to drug resistance.
“With gonorrhoea, clearly, antibiotic prophylaxis is not the way to go, and we need to find other interventions,” Molina said. “A vaccine would be great, and there are a number of ongoing trials to look at vaccines for gonorrhoea. So far, we’ve seen very disappointing results, but let’s hope that in future, we get better results.”
