Doxycycline Prophylaxis for Skin and Soft Tissue Infections in Naval Special Warfare Trainees, United States1

Emerg Infect Dis. 2024 Jan;30(1):89-95. doi: 10.3201/eid3001.230890.


In 2015, several severe cases of skin and soft tissue infection (SSTI) among US Naval Special Warfare trainees prompted the introduction of doxycycline prophylaxis during the highest-risk portion of training, Hell Week. We performed a retrospective analysis of the effect of this intervention on SSTI incidence and resulting hospital admissions during 2013-2020. In total, 3,371 trainees underwent Hell Week training during the study period; 284 SSTIs were diagnosed overall, 29 of which led to hospitalization. After doxycycline prophylaxis was introduced, admission rates for SSTI decreased from 1.37 to 0.64 admissions/100 trainees (p = 0.036). Overall SSTI rates remained stable at 7.42 to 8.86 SSTIs/100 trainees (p = 0.185). Hospitalization rates per diagnosed SSTI decreased from 18.4% to 7.2% (p = 0.009). Average length of hospitalization decreased from 9.01 days to 4.33 days (p = 0.034). Doxycycline prophylaxis was associated with decreased frequency and severity of hospitalization for SSTIs among this population.

Keywords: SSTI; United States; bacteria; doxycycline; military; prophylaxis; saltwater exposure; skin and soft tissue infection.

MeSH terms

  • Doxycycline* / therapeutic use
  • Hospitalization
  • Humans
  • Retrospective Studies
  • Skin
  • Soft Tissue Infections* / epidemiology
  • Soft Tissue Infections* / prevention & control
  • United States / epidemiology


  • Doxycycline