Sexual health, the practical version

The short version

• PrEP is very effective at preventing HIV when you take it as prescribed. Pills or shots.
• Condoms also cut the risk of other STIs that PrEP doesn't touch.
• Test regularly: every three months if you're having sex with new or multiple partners.
• PEP within 72 hours if you think you were exposed to HIV and aren't on PrEP.
• DoxyPEP after sex lowers the chance of syphilis and chlamydia. Ask if it's right for you.
• Undetectable = Untransmittable (U=U): someone living with HIV who keeps an undetectable viral load doesn't pass HIV on through sex.

PrEP: your options

All PrEP needs an HIV test first and regular check-ins. In the US, most insurance covers it, and there are programs that make it free or cheap if you're uninsured. Your local LGBTQ health center can help you sort it out.

PEP: the morning-after option for HIV

If a condom broke, you weren't on PrEP, or you're not sure, PEP is a 28-day course of HIV medicine that can stop an infection taking hold. It has to start within 72 hours, and the sooner the better. Go to an urgent care, an ER or a sexual health clinic and ask for it by name. It's also a good moment to ask about starting PrEP.

DoxyPEP

A single dose of the antibiotic doxycycline (200 mg), taken within 72 hours after condomless sex (ideally within 24), substantially lowers the chance of getting syphilis and chlamydia, and lowers gonorrhea less. US guidance since 2024 recommends offering it to gay and bi men who've had a bacterial STI in the past year. It isn't for everyone, so talk it through with your clinic.

Condoms and lube

• Condoms protect against HIV and lower the risk of most other STIs, including the ones PrEP doesn't cover.
• Use water-based or silicone lube with latex condoms. Oil-based products (lotion, coconut oil, Vaseline) weaken latex and make breaks more likely.
• Fit matters: a condom that's too tight or too loose is more likely to break or slip. Try a couple of sizes.

Testing: what and how often

• How often: at least once a year for everyone who's sexually active, and every three months if you have new or multiple partners or you're on PrEP.
• What: HIV, syphilis (a blood test), and gonorrhea and chlamydia at every site you use: throat, rectum and urine. A urine test alone misses a lot of infections in the throat and rectum.
• Many STIs have no symptoms, which is exactly why regular testing matters.
• Lots of clinics offer free or low-cost testing, and some do at-home kits by mail.

Vaccines worth asking about

• HPV: recommended through age 26, and an option up to 45. It protects against genital warts and several cancers, including anal and throat cancer.
• Hepatitis A and B: two common, preventable infections. Many guys have never had both.
• Mpox (JYNNEOS): two doses, four weeks apart.
• Ask your clinic whether any others, like meningococcal, make sense for you.

Talking about it

The status conversation is easier when it's matter-of-fact and early:

• “I'm on PrEP and test every three months. When were you last tested?”
• “I'm positive and undetectable, so I can't pass it on. Happy to answer questions.”
• “I'd like to use condoms. That work for you?”

Anyone who gets weird about a health conversation has told you something useful.

Finding care that doesn't judge

LGBTQ health centers exist in most big cities and many smaller ones, and every city guide lists them. You can also search for an LGBTQ-friendly provider by ZIP code. If a provider makes you feel judged, it's fine to switch. Questions you'd rather ask peers first? Try Sex & Health.