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Mens Sexual Health STI Prevention and Prep

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In one line

·Sexual health is real medicine — ask about it, test for it, vaccinate, and prevent what you can before it spreads or breaks something downstream.

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Normal physiology

·Healthy male sexual function is a coordinated job between blood vessels, nerves, hormones, and the brain. An erection happens when nerve signals tell arteries in the penis to relax and fill three spongy chambers (the corpora cavernosa — think of them as three long balloons inside the shaft of the penis) with blood, while veins squeeze shut to trap that blood and keep the penis firm. Testosterone (the main male hormone made in the testes, the two glands in your scrotum) fuels sex drive, sperm production, muscle and bone strength, and mood. The limbic system in your brain (especially the hypothalamus, which controls hunger and hormones, and the amygdala, your alarm center) runs desire and arousal. The autonomic nervous system (the part you cannot control on purpose, like your heartbeat) runs the mechanics of erection and ejaculation. Your skin and the mucous membranes (the wet, delicate lining of your genitals, mouth, and rectum) are the first barrier against germs. Keep this normal picture in your head, because every sexual health problem is a break in one or more of these jobs.

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What goes wrong

·Men's sexual health breaks when infection, blood vessel disease, low hormones, mental health problems, or medication side effects mess up the normal blood flow, nerve signals, testosterone levels, or brain circuits that run sexual function. The most common upstream breaks are sexually transmitted infections — bacteria like gonorrhea (Neisseria gonorrhoeae), chlamydia (Chlamydia trachomatis), and syphilis (Treponema pallidum), and viruses like HIV, herpes (HSV-2 or HSV-1), and HPV (human papillomavirus) — erectile dysfunction (often from diabetes damaging nerves and blood vessels or fatty plaque clogging the small arteries in the penis), low testosterone (hypogonadism, from aging, obesity, long-term pain pills, or your pituitary gland not sending the right hormone signals), anxiety and depression (which dampen the limbic system's arousal signals and keep the fight-or-flight system turned on), and drugs (antidepressants, blood pressure pills, alcohol, opioids like oxycodone or morphine) that interfere with erections or desire. Many men do not report these problems unless the doctor asks directly, because of shame or the belief that sexual issues are not 'real' medical problems. That silence lets infections spread silently to partners and lets complications build over years — infertility, heart disease, brain damage, blindness in newborns, AIDS.

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Hallmark signs

·Discharge from the penis (clear, white, yellow, or green)
·Burning or pain when you pee
·Sores, blisters, or ulcers on or around the penis, scrotum, or anus
·Itching or tingling around the genitals or anus
·Swollen, tender lymph nodes in the groin
·Pain or swelling in one or both testicles
·Rectal pain, discharge, or bleeding
·Fever, body aches, or flu-like feeling

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Red flags · escalate now

·Sores or ulcers on the genitals—may be syphilis (a single painless firm sore) or herpes (grouped painful blisters). Both need immediate testing and treatment to stop spread, prevent complications, and protect partners.
·Swollen, painful testicle—signals epididymitis, meaning infection has climbed into the reproductive tubes. Without fast antibiotic treatment, scarring can block sperm flow and threaten fertility.
·Fever plus genital symptoms—means the infection may be spreading into the bloodstream or deeper organs (disseminated gonorrhea, secondary syphilis, or acute HIV). Requires urgent evaluation and antibiotics.
·Severe belly pain in a partner—if a female partner develops pelvic or lower belly pain, it may be pelvic inflammatory disease (PID) from gonorrhea or chlamydia you passed on. She needs urgent care, and you need testing and treatment to stop further transmission.
·Acute HIV infection signs (fever, rash, swollen glands, sore throat within 2–4 weeks of exposure)—early antiretroviral treatment started during this window dramatically lowers the amount of virus in the body and improves long-term health.

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Workup

·Nucleic acid amplification test (NAAT) for Neisseria gonorrhoeae and Chlamydia trachomatis from first-catch urine (or urethral swab), rectal swab, and pharyngeal (throat) swab
·Syphilis serology: nontreponemal test (RPR or VDRL) plus treponemal test (TP-PA, TP-EIA, or FTA-ABS)
·HIV antigen/antibody combination test (4th-generation enzyme immunoassay, or EIA) with reflex to HIV-1/HIV-2 differentiation immunoassay and HIV-1 RNA viral load if positive
·Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core antibody total (anti-HBc total)
·Hepatitis C antibody (anti-HCV) with reflex to hepatitis C virus RNA (HCV RNA) if antibody is positive
·Serum creatinine and estimated glomerular filtration rate (eGFR) before starting tenofovir-based PrEP and every 3 to 6 months while taking it
·Gonorrhea culture with antimicrobial susceptibility testing if NAAT detects pharyngeal gonorrhea or if treatment fails and symptoms persist after 7 days
·Test of cure: repeat NAAT 3 months after completing treatment for gonorrhea or chlamydia

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Treatment

·Ceftriaxone 500 mg intramuscular (IM) single dose (use 1 gram IM if weight is 150 kg or more) PLUS doxycycline 100 mg by mouth twice daily for 7 days
·Daily oral PrEP: tenofovir disoproxil fumarate 300 mg plus emtricitabine 200 mg (Truvada or generic) by mouth once daily, OR tenofovir alafenamide 25 mg plus emtricitabine 200 mg (Descovy) once daily, for cisgender men and transgender women at high HIV risk
·Long-acting injectable PrEP: cabotegravir 600 mg intramuscular (IM) every 2 months (after two initial loading doses 1 month apart) for cisgender men and transgender women at high HIV risk
·Doxycycline post-exposure prevention (prophylaxis) (doxy-PEP): doxycycline 200 mg by mouth as a single dose within 24 to 72 hours after condomless sex
·Expedited partner therapy (EPT): give the patient a prescription or a medication pack — ceftriaxone 500 mg IM plus doxycycline 100 mg twice daily for 7 days — to deliver directly to their sexual partner(s) without the partner seeing a clinician first
·Benzathine penicillin G 2.4 million units intramuscular (IM) single dose for primary syphilis (painless ulcer called a chancre), secondary syphilis (rash on palms and soles, mucous patches, or condyloma lata), or early latent syphilis (infection less than 1 year); OR three weekly doses (2.4 million units IM each week for 3 weeks) for late latent or unknown-duration syphilis
·Hepatitis B vaccine series: Engerix-B 20 micrograms or Recombivax HB 10 micrograms or Heplisav-B 20 micrograms intramuscular (IM) at 0, 1, and 6 months (or Heplisav-B at 0 and 1 month) for all non-immune sexually active adults, especially men who have sex with men, people with HIV, and people with multiple sexual partners

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NCLEX trap

·Start ceftriaxone (an antibiotic shot that kills gonorrhea bacteria) plus doxycycline (an antibiotic pill that kills chlamydia bacteria) right away when you suspect gonorrhea or chlamydia. Do not wait. These germs spread to his partner fast during sex and can cause pelvic inflammatory disease (scarring and swelling in a woman's uterus and tubes) that leads to infertility. The test confirms which germ it is and guides partner treatment, but treatment starts today to stop the chain of infection and prevent complications in both the patient and his partner.
·Many men carry gonorrhea (Neisseria gonorrhoeae bacteria), chlamydia (Chlamydia trachomatis bacteria), and early syphilis (Treponema pallidum bacteria) with zero symptoms. The germs live quietly in the urethra (the tube that carries pee and semen out of the penis) or rectum and spread during sex even when the person feels fine. The CDC says screen on schedule — yearly for sexually active men, every 3 months if high-risk (multiple partners, condomless sex, or sex with men) — even when there are no complaints. Invisible infection still does harm: untreated chlamydia and gonorrhea climb up the reproductive tract and cause epididymitis (painful swelling of the coiled tubes behind the testicle that store sperm) in men and pelvic inflammatory disease in women, leading to infertility.
·PrEP (tenofovir/emtricitabine, drugs that block HIV from copying itself inside immune cells) is for men at high risk for HIV: condomless sex with multiple partners, a partner who has HIV with a detectable viral load (meaning the virus is actively multiplying in their blood), or injection drug use. Always do an HIV antibody/antigen combo test (to make sure he does not already have HIV) and a creatinine test (to check kidney function) first. Do not give PrEP to someone who already has HIV — the dose is too low to treat the virus, and it breeds resistance (the virus learns to survive despite the drug). He needs full HIV treatment (a combination of at least three antiretroviral drugs) instead. Also, tenofovir can hurt the kidneys over time by damaging the tubules (the tiny filtering tubes inside the kidney that clean waste from the blood), so you must check creatinine every 3 months while he is on PrEP.
·Partner notification and expedited partner therapy (EPT, giving the patient medicine to take home to his partner) are core to men's sexual health STI prevention. If you do not treat the partner, she stays infected and passes it back to him during sex (called ping-pong infection). Worse, untreated chlamydia and gonorrhea in women climb from the cervix (the opening to the uterus) into the uterus and fallopian tubes (the tubes that carry eggs from the ovaries), causing pelvic inflammatory disease (PID, swelling and scarring inside the pelvis). PID scars the tubes shut and leads to infertility (she cannot get pregnant) or ectopic pregnancy (a pregnancy stuck in the tube that can burst, bleed into the belly, and kill her). Always counsel the patient to notify his partners from the past 60 days and bring them in for testing and treatment, or use EPT where legal.
·Genital ulcers can be syphilis, herpes (herpes simplex virus, HSV), or chancroid (a rare bacterial infection caused by Haemophilus ducreyi). Syphilis is the dangerous miss — if untreated, Treponema pallidum bacteria spread through the blood and over months to years attack the brain (causing neurosyphilis, which leads to dementia, blindness, or stroke) and the heart (causing aortitis, swelling of the aorta that makes it tear or leak). Do an RPR or VDRL (blood tests that screen for antibodies your body makes against syphilis) plus a confirmatory test like FTA-ABS or TP-PA (tests that look for antibodies that specifically bind to syphilis bacteria) or dark-field microscopy of the ulcer fluid (looking at the fluid under a special microscope to see the corkscrew-shaped syphilis bacteria moving). Do not guess by appearance alone. Herpes recurs and causes painful blisters, but it rarely kills; untreated syphilis can.

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