Gay & bisexual men — thewarmbed

Men who have sex with men carry a higher share of certain infections — HIV and syphilis especially — for reasons of network math and anatomy, not morality. The genuinely good news is that this is also the group with the most powerful, best-developed prevention toolkit in all of sexual health. Used well, it makes for sex that's both safer and less anxious. Here's the practical version. ("Men who have sex with men" is the clinical framing because it's about behavior and anatomy, not how anyone identifies.)

PrEP: the centerpiece

If you have condomless anal sex with partners whose status you don't know, or whose HIV isn't confirmed undetectable, PrEP belongs in your life. It cuts HIV risk from sex by roughly 99% and comes in several forms: a daily pill (cheap as a generic), on-demand "2-1-1" dosing (two pills 2–24 hours before sex, one at 24h, one at 48h — well-suited to anal sex and endorsed for MSM when sex is episodic), a shot every two months, and the newer twice-yearly injection. PrEP requires HIV testing before and every three months, which conveniently doubles as your regular screening. It's standard preventive care — providers prescribe it like any other.

U=U changes the picture

Worth stating plainly because it reshapes risk and stigma both: a partner living with HIV who's on treatment with an undetectable viral load cannot transmit it sexually — Undetectable = Untransmittable, settled science. A serodifferent couple where the positive partner is undetectable is not an HIV transmission risk. This fact matters for how you assess partners and for treating people living with HIV as, well, people.

Testing: find what urine tests miss

The most common testing mistake is a urine-only screen. Gonorrhea and chlamydia set up quietly in the throat and rectum, where a urine test can't see them — so ask for site-specific swabs (throat and rectal) based on the sex you have. Many clinics offer self-collected swabs behind a curtain. Cadence: at least yearly if you're sexually active, every 3–6 months with multiple or anonymous partners, always including HIV and syphilis. Syphilis in particular is resurgent among MSM and often symptomless or easily missed, so it earns its place every time. Full timing logic lives in the testing guide.

doxyPEP: newer prevention

A significant recent addition: taking a single dose of doxycycline within 72 hours after condomless sex substantially reduces the risk of chlamydia and syphilis, and is now guideline-recommended in several places specifically for MSM and transgender women with a recent bacterial STI. Its effect on gonorrhea is more modest and watched for resistance. If bacterial STIs keep finding you, it's a specific, evidence-based conversation to have with your clinic — by name.

Safer (and better) anal sex

Anal sex carries the highest per-act HIV risk of common activities, which is exactly why the toolkit above matters — but comfort and mechanics deserve real attention too:

Lube is not optional. The rectum makes none of its own and its tissue is thin and tear-prone; generous lube reduces both discomfort and the micro-tears that raise infection risk. Thick water-based or silicone are the picks. Latex + oil = breakage.
Go slow, communicate, and never use numbing products — pain is the tissue's signal to slow down, add lube, or stop; anesthetizing it invites injury.
Condoms still block the STIs PrEP doesn't — pairing PrEP with condoms (or with frequent testing and doxyPEP) is the fuller picture, not either/or.
Hepatitis A and B are vaccine-preventable and recommended — a quick, lasting layer of protection worth asking about. HPV vaccination is likewise worthwhile.

Bi men, specifically

Bisexual men get erased in both directions and sometimes skip care to avoid disclosure hassles. Two things: your health needs are simply the sum of the sex you actually have, so a good provider needs the honest picture (which partners, which activities, which sites) to test and protect you properly — and you deserve one who takes that without a flicker. Biphobia is real; a judgmental provider is a reason to switch, not to under-share.

When to see a clinician

To start PrEP or ask about doxyPEP; for site-specific screening on the cadence above; for hepatitis and HPV vaccination; promptly for any sore, rash (including on palms or soles — a classic syphilis sign), discharge, or anal symptoms; and urgently within 72 hours for PEP after a possible HIV exposure if you're not on PrEP. Find a provider who knows LGBTQ+ health — sexual health clinics and LGBTQ+ centers are the reliable starting points. (Queer women get their own guide too: lesbian & queer womensoon.)

This guide is educational and not medical advice. It can't account for your history or circumstances — a clinician can. Read our full medical disclaimer.