Sexually transmitted infections (STIs) in men can be caused by bacteria, viruses, or parasites. Patients present primarily with urethritis or skin manifestations. The most common STIs affecting men include gonorrhea; chlamydia; Mycoplasma and Ureaplasma infections; trichomoniasis; syphilis; chancroid; mpox (monkeypox); and infections with human papillomavirus; herpes simplex virus; hepatitis A, B, and C viruses; and HIV. Primary and secondary prevention strategies include vaccination, preexposure prophylaxis, condom use, and routine screening to reduce transmission and improve clinical outcomes. A thorough sexual history should be obtained from patients using the Centers for Disease Control and Prevention’s 5Ps framework (ie, partners, practices, protection from STIs, past history of STIs, pregnancy intention). The National Coalition for Sexual Health has suggested a sixth P—plus—that represents pleasure, problems, and pride. The latest recommendations for prevention measures include doxycycline postexposure prophylaxis (doxy PEP) for certain high-risk groups.

Case 4. GD, a 28-year-old cisgender man, presents with dysuria and purulent urethral discharge. He reports having multiple sexual partners in the past 6 months and using condoms inconsistently. Results of initial laboratory tests, including nucleic acid amplification tests for Neisseria gonorrhoeae and Chlamydia trachomatis, are positive for gonorrhea.

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