Nobody sits you down and explains this stuff.
Sex ed skipped it. Your college health center probably skipped it. And a lot of doctors, bless them, still don’t know to ask the right questions.
So here it is: the gay men’s sexual health checklist you should have gotten years ago. Six things, no lectures, no shame.
At Maze Men’s Health, this is a normal Tuesday conversation. Let’s get into it.
1. Get Tested at All Three Sites (Not Just One)
This is the single most common mistake in gay men’s sexual health, and it’s not the patient’s fault.
Here’s the problem: rectal and throat gonorrhea and chlamydia are usually completely asymptomatic. No burning, no discharge, no clue. And they don’t show up in a urine test.
The numbers are eye-opening. In a national dataset of over 81,000 men who have sex with men, 48% were tested at the genital site only, and just 25% were tested at all three sites. Meanwhile, rectal chlamydia positivity was 9.8% and rectal gonorrhea 7.3%.
Put another way: urine-only screening in an STI clinic setting misses about 83% of infections in this population.
What to actually do: The CDC recommends screening at least annually, HIV, syphilis, plus gonorrhea and chlamydia at every site of exposure (urethra, rectum, throat), regardless of condom use. If you have multiple or anonymous partners, that becomes every 3 to 6 months.
Modeling data suggests quarterly screening isn’t just better for you, it dramatically cuts community transmission.
Pro tip: Self-collected swabs are validated and can make this a lot less awkward. Ask for them.
2. PrEP Isn’t Just a Daily Pill Anymore
If you’re not on PrEP and you’re sexually active with men, this conversation is worth having.
Why: condomless receptive anal sex carries roughly a 10- to 15-fold higher transmission risk than condomless insertive anal sex or penile-vaginal sex. And HIV prevalence among men who have sex with men has been estimated at around 12.4%, versus 0.3% in the general U.S. population.
The good news? Options have expanded:
-
Daily oral PrEP — the original, still excellent
-
Injectable cabotegravir (Apretude) — an FDA-approved long-acting injection for HIV prevention, no daily pill
Efficacy tracks closely with adherence, which is exactly why the injectable option is a game-changer for some guys.
One important note: anyone starting PrEP needs a documented negative HIV test first, and follow-up testing is part of the deal.
Despite all this, PrEP uptake remains lower than it should be, with the widest gaps among Black and Hispanic men. If nobody’s offered it to you, that’s a system failure, not a personal one.
3. DoxyPEP: The Thing You Probably Haven’t Heard About
This one is genuinely newer, and it’s a big deal.
DoxyPEP is a single 200 mg dose of doxycycline taken within 72 hours after condomless sex to prevent bacterial STIs. Across three large randomized trials, it reduced syphilis and chlamydia by over 70% and gonorrhea by roughly 50%.
In the landmark DoxyPEP trial, STI incidence dropped by about two-thirds, from 31.9% of quarterly visits down to 10.7% among men on HIV PrEP.
Who it’s for: The CDC recommends that gay, bisexual, and other men who have sex with men, and transgender women, who’ve had syphilis, chlamydia, or gonorrhea diagnosed in the past 12 months be counseled about doxyPEP and offered a prescription through shared decision-making.
The fine print that matters: Max dose is 200 mg every 24 hours. If you’re on doxyPEP, you still need STI testing at all exposure sites every 3 to 6 months, and your ongoing need should be reassessed at those visits. Tetracycline-resistant gonorrhea was seen more often in the doxycycline group in the trial, so this is a real medical decision, not a party favor.
4. Vaccines: The Boring Heroes
Genuinely the lowest-effort, highest-return item on this list.
-
HPV vaccine — recommended through age 26, and shared decision-making for ages 27 to 45. HPV causes anal, oropharyngeal, and penile cancers. This is cancer prevention.
-
Hepatitis A — recommended for all men who have sex with men over 19 who haven’t had it
-
Hepatitis B — recommended, including a two- or three-dose series for men over 60 who haven’t been vaccinated
-
Mpox (JYNNEOS) — a 2-dose series recommended for gay, bisexual, and other men who have sex with men with a recent STI, multiple partners, or sex at commercial venues or large events in the past 6 months. Real-world effectiveness for full vaccination has been estimated at 66% to 86%. Breakthrough cases tend to be milder.
If you got one mpox dose in 2022 and never went back, go get the second one.
5. Anal Health Is Health (Let’s Just Say It)
Anal cancer is rare in the general population, about 1–2 cases per 100,000 per year. But among gay and bisexual men, especially those living with HIV, rates climb dramatically, reaching up to 85 per 100,000 in some estimates.
Here’s why this matters now: the ANCHOR trial showed that finding and treating high-grade anal lesions reduced progression to cancer by 57% in people with HIV. That changed the field.
Current guidance: Both the International Anal Neoplasia Society and HHS recommend annual anal cancer screening for men who have sex with men living with HIV starting at age 35, and at 45 for other people with HIV. Screening can include anal cytology, high-risk HPV testing, and a digital anorectal exam.
For men without HIV who have a history of receptive anal sex, the CDC recommends a digital anorectal exam to detect early anal cancer, though data are still considered insufficient to recommend routine anal cytology screening in this group.
And regardless of screening status: anal bleeding, persistent pain, unexplained itching, or a new lump deserves an actual exam. Not a Reddit thread. Anal pain plus discharge can signal proctitis, which needs testing for gonorrhea, chlamydia, and syphilis, and possibly treatment for lymphogranuloma venereum.
6. Your Mental Health Is Part of Your Sexual Health
This isn’t filler. It’s data.
Gay and bisexual men experience substantially higher rates of anxiety, depression, and substance use than demographically matched heterosexual men, largely driven by minority stress from growing up in non-affirming environments.
And it shows up in the bedroom. In a study of young men who have sex with men, higher depression and stress were associated with worse sexual functioning, lower sexual satisfaction, and more anal discomfort. In another large study of gay men, those reporting multiple sexual problems were significantly more likely to have major depression, with erectile dysfunction and low desire being the most commonly reported issues.
So if sex has felt off lately, the answer might not be a pill. Or it might be a pill and a conversation. Either way, it’s worth naming.
The Thing That Ties It All Together
Every guideline says some version of the same thing: good care starts with a provider who actually takes a real sexual history, without flinching.
That means asking about anatomy of exposure, partners, substance use, and mental health in a way that’s matter-of-fact rather than loaded. Because you can’t get screened at the right sites if nobody asks the right questions.
If you’ve ever left a doctor’s office having not mentioned something because it felt easier, you already know why this matters.
Where Maze Men’s Health Comes In
At Maze Men’s Health, we provide sexual health care for gay and bisexual men that’s comprehensive, current, and completely judgment-free.
That includes:
-
Full three-site STI testing, throat, rectal, urethral, plus HIV and syphilis
-
PrEP evaluation and management, including long-acting options
-
DoxyPEP counseling and prescribing
-
Vaccine review, HPV, hepatitis A and B, mpox
-
Anal health evaluation and appropriate screening referrals
-
Sexual function care, ED, low libido, low testosterone
-
A real sexual history taken by someone who’s had this conversation a thousand times
The Bottom Line
Most of what threatens gay men’s sexual health is asymptomatic, screenable, and preventable. The tools exist. They’re just unevenly offered.
Three-site testing. PrEP. DoxyPEP. Vaccines. Anal health. Mental health. That’s the checklist.
Book a Confidential Visit with Maze Men’s Health
References
-
Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. CDC MMWR Recommendations and Reports, 2021.
-
Bachmann LH, Barbee LA, Chan P, et al. CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024. CDC, 2024.
-
Luetkemeyer AF, Donnell D, Dombrowski JC, et al. Postexposure Doxycycline to Prevent Bacterial Sexually Transmitted Infections. New England Journal of Medicine, 2023.
-
McMullan S, Anderson T, Elhage N. Preventive Care for Men Who Have Sex With Men. American Family Physician, 2024.
-
US Preventive Services Task Force. Preexposure Prophylaxis to Prevent Acquisition of HIV: USPSTF Recommendation Statement. JAMA, 2023.
-
Benson C, Brooks J, Dhanireddy S, et al. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV — Human Papillomavirus Disease. HHS/Office of AIDS Research Advisory Council.