What are the most effective methods for adult men to practice safe sex and prevent sexually transmitted infections (STIs)?

Safe Sex Practices in Men

Primary Prevention Strategy

Consistent and correct use of male latex condoms is the most effective method for sexually active men to prevent HIV and other sexually transmitted infections, with protection rates of 80-95% against HIV when used properly. 1, 2

Condom Use: The Cornerstone of STI Prevention

Evidence for Effectiveness

• Multiple cohort studies of serodiscordant couples demonstrate strong protective effects of condom use against HIV infection, making this the highest-quality evidence available for any barrier method 1
• Condoms provide superior protection against infections transmitted between mucosal surfaces (HIV, gonorrhea, chlamydia) compared to skin-to-skin transmitted infections (herpes, HPV, syphilis) where exposed areas may not be covered 1, 2
• Condom failure rates are low (≤2 per 100 condoms used) and typically result from incorrect or inconsistent use rather than breakage 1, 2

Critical Requirements for Effectiveness

Condoms must be used consistently (every act of intercourse) and correctly to achieve maximum protection. 1

The following steps ensure proper condom use:

• Use a new condom with each act of sexual intercourse 1
• Handle carefully to avoid damage from fingernails, teeth, or sharp objects 1
• Put the condom on after the penis is erect and before any genital contact with the partner 1
• Ensure no air is trapped in the tip 1
• Ensure adequate lubrication during intercourse, using exogenous lubricants if needed 1
• Use only water-based lubricants (K-Y Jelly, Astroglide, AquaLube, glycerin) with latex condoms—never oil-based lubricants (petroleum jelly, mineral oil, massage oils, body lotions, cooking oil) as these weaken latex 1, 2
• Hold the condom firmly against the base of the penis during withdrawal, and withdraw while the penis is still erect to prevent slippage 1

Common Pitfall

The most critical error is inconsistent use—approximately 69% of sexually active men do not use condoms consistently, even among those with multiple partners or high-risk behaviors 3. Men frequently cite decreased sexual pleasure, trust in regular partners, or condom-associated erection problems as reasons for non-use 4. However, the effectiveness of condoms depends entirely on consistent use; occasional use provides inadequate protection. 5

Pre-Exposure Vaccination

All men should receive hepatitis B vaccination if not previously vaccinated, as HBV is frequently sexually transmitted. 1, 6

• Complete the full 3-dose series (0,1-2 months, 6 months) 6
• Hepatitis A vaccination is specifically recommended for men who have sex with men 1, 6

Partner Testing and Communication

Both partners should be tested for STDs, including HIV, before initiating sexual intercourse. 1

• This strategy allows informed decision-making and appropriate precautions based on actual infection status 1
• Testing should include chlamydia, gonorrhea, syphilis, and HIV at minimum 6

Post-Exposure Prophylaxis Considerations

If a risky sexual encounter has occurred, post-exposure prophylaxis must be initiated within 72 hours of exposure. 6

• Doxycycline 200 mg within 72 hours of condomless sex is considered for men who have sex with men as part of comprehensive STI care 6
• HIV post-exposure prophylaxis with antiretroviral therapy must also be initiated within this 72-hour window 6

Screening Recommendations for High-Risk Men

Men with ongoing high-risk behaviors require regular screening regardless of condom use:

• Screen every 3-6 months for men with multiple or anonymous partners, substance use during sex, or previous STI history 6
• Comprehensive screening should include nucleic acid amplification tests (NAATs) for chlamydia and gonorrhea on urine specimens, plus serologic testing for HIV and syphilis 6, 7
• Site-specific testing is essential: rectal specimens for receptive anal intercourse, pharyngeal specimens for receptive oral sex 6
• Failing to test at exposure-specific sites misses a substantial proportion of infections, particularly in men who have sex with men 6

What Doesn't Work

Spermicides

• The effectiveness of spermicides in preventing HIV transmission is unknown 1
• No data indicate that condoms lubricated with spermicides are more effective than other lubricated condoms for STD prevention 1
• Spermicide-coated condoms have been associated with urinary tract infections 1

Female Condoms

• While laboratory studies show the female condom is an effective mechanical barrier to viruses including HIV, clinical effectiveness data are limited 1, 7
• Female condoms should be considered only when male condoms cannot be used appropriately 1, 7
• The 12-month pregnancy failure rate of 26% suggests challenges with consistent and correct use 1, 7

Risk Reduction Counseling

Primary prevention through behavior change remains fundamental to STD control. 1

• Abstaining from sexual activity or restricting sex to mutually monogamous uninfected partners provides complete protection 1, 5
• Reducing the number of sexual partners decreases STI risk 1
• Knowledge of infection status is associated with reductions in high-risk behaviors across all populations studied 6