By admin 
Every single day, the global health community grapples with a staggering reality: more than one million new cases of potentially curable sexually transmitted infections (STIs) are diagnosed across the planet. This figure, provided by the World Health Organization (WHO), represents only the tip of the iceberg, as many infections remain asymptomatic and undiagnosed, quietly fueling a persistent epidemic. Simultaneously, the state of global reproductive health remains in a precarious balance. Recent data published in The Lancet reveals that of the 250 million pregnancies occurring annually, approximately half are unplanned. These two crises—the rampant spread of STIs and the high rate of unintended pregnancies—are inextricably linked, yet they share a common, glaring oversight in public policy and clinical practice: the systemic neglect of men’s sexual and reproductive health.
At specialized clinics from Boston to Bangkok, medical professionals are witnessing an alarming uptick in infection rates. Despite decades of advocacy and scientific advancement, the burden of reproductive responsibility and the focus of preventative care have remained disproportionately centered on women. By overlooking men, health systems are effectively ignoring half of the equation, leaving a massive gap in the global strategy to stabilize population growth and eradicate communicable diseases. It is no longer a matter of clinical preference but a public health necessity to pivot toward a comprehensive model that integrates men into the reproductive health framework.
The disparity in reproductive options is perhaps the most visible manifestation of this neglect. While women have access to dozens of contraceptive methods—ranging from daily pills and patches to long-acting reversible contraceptives (LARCs) like IUDs and implants—male-focused options have remained virtually stagnant for over a century. Aside from the male condom and vasectomy, no new contraceptive for men has successfully entered the market in more than 100 years. This lack of innovation is not due to a lack of biological possibility, but rather a profound deficit in financial backing and pharmaceutical interest. Consequently, less than a quarter of men globally utilize any form of birth control, leaving the emotional, physical, and financial weight of pregnancy prevention almost entirely on their female partners.
This historical oversight impedes reproductive health outcomes for everyone. As a physician and professor who has spent 40 years on the front lines of HIV and STI prevention, I have seen the direct consequences of this gap. In clinical settings, we frequently encounter young men who are fundamentally unaware of their own reproductive risks. Many do not realize that the majority of STIs—including chlamydia, gonorrhea, and even early-stage syphilis—can be entirely asymptomatic. Without routine screening and education tailored to men, these individuals become unwitting vectors for transmission, often realizing they are infected only after a partner develops symptoms or complications.
The epidemiological data underscores the urgency of engaging men more effectively. Statistically, men tend to have a higher number of lifetime sexual partners than women, which increases the probability of spreading infections within a community. This is particularly critical within the population of men who have sex with men (MSM). Although MSM constitute roughly 5% of the U.S. population, Centers for Disease Control and Prevention (CDC) data indicates they accounted for over 30% of all syphilis cases in 2023. These figures are not merely a reflection of sexual behavior but are often a byproduct of systemic barriers. Sexual and gender minorities frequently delay seeking care due to the justified fear of stigma or mistreatment by healthcare providers who lack cultural competency. When men are marginalized by the healthcare system, the entire community’s viral load increases, making the goal of "getting to zero" new infections an impossibility.
Fortunately, the tide of medical science is beginning to turn, albeit slowly. For nearly 85 years, researchers have possessed a basic understanding of how hormonal male contraception could function. The biological mechanism involves mimicking the body’s natural feedback loops to suppress the signals that trigger sperm production, a process known as spermatogenesis. Unlike female hormonal contraception, which must manage a monthly cycle, male contraception must address the continuous production of millions of sperm. However, research conducted since the 1970s has proven that when these hormone regimens are discontinued, sperm counts return to normal, and fertility is restored, debunking long-standing myths about permanent sterility.
Currently, several promising products are entering late-stage clinical trials. One of the most anticipated is NES/T, a topical gel that combines progestin (to block sperm production) and testosterone (to maintain normal physiological functions like libido). Early results have shown the gel to be highly effective with no serious side effects. Furthermore, synthetic testosterone derivatives that can be administered as a once-daily oral pill are also undergoing rigorous testing. If these trials receive the necessary funding and regulatory support, a viable hormonal male birth control could be commercially available before 2030. The introduction of even one new method could be transformative; historical data from the WHO suggests that for every new contraceptive option introduced to a population, there is a 12% increase in overall contraceptive use. By giving men more agency, we reduce the global rate of unplanned pregnancies and foster a more equitable distribution of reproductive labor.
The evolution of science is equally promising in the realm of STI prevention. The last decade has seen monumental breakthroughs in antiretroviral therapy (ART) for HIV. We have reached a point where the medical community has the tools to ensure that HIV is no longer a death sentence and, through the principle of "Undetectable = Untransmittable" (U=U), that the virus cannot be sexually transmitted by those on effective treatment. Yet, despite these tools, new infections persist. In 2023, men accounted for more than 80% of the 39,000 new HIV diagnoses in the United States. Two-thirds of these cases were among MSM, highlighting the ongoing struggle with treatment adherence and healthcare access.
To bridge this gap, researchers are moving away from daily pill burdens toward long-acting solutions that better fit into the complexities of modern life. In July 2023, the FDA approved biannual injections of Lenacapavir for HIV Pre-Exposure Prophylaxis (PrEP). This follows the success of Cabotegravir, which is administered every two months. Future research is already targeting yearly injections or monthly pills, which would revolutionize prevention for those who find daily medication regimens difficult to maintain. However, the very success of HIV prevention has created a secondary challenge: as the fear of HIV diminishes, condom use has declined, leading to a resurgence in other STIs like gonorrhea.
The rise of "super-gonorrhea"—strains of the bacteria that are increasingly resistant to all known antibiotics—is one of the most pressing threats in modern medicine. While heterosexual men and women contract the disease at similar rates, MSM accounted for approximately 40% of all gonorrhea cases in the U.S. in 2022. In this fight, vaccines represent the most sustainable hope. Interestingly, the bacteria that causes meningitis (Neisseria meningitidis) shares significant genetic similarities with the bacteria that causes gonorrhea (Neisseria gonorrhoeae). Recent studies have shown that the meningococcal serogroup B (MenB) vaccine provides a degree of cross-protection against gonorrhea. While clinical trials have yielded mixed results, large-scale definitive trials are currently underway to determine if this existing vaccine can be repurposed as a primary tool for gonorrhea prevention. Beyond gonorrhea, the scientific community is also in the early stages of developing vaccines for syphilis, chlamydia, and herpes simplex virus Type 2.
The recent global response to the mpox (formerly monkeypox) outbreak of 2022 provides a definitive roadmap for how targeted intervention can work. When mpox began spreading rapidly within the MSM community, organizations like Fenway Health in Boston moved with unprecedented speed. By launching educational campaigns, providing immediate treatment, and administering over 6,000 doses of the Jynneos vaccine within five months, they were able to halt the transmission of a disease that had threatened to become a permanent endemic fixture. This success was built on three pillars: existing research, community trust, and immediate funding.
However, the progress we have made is currently under threat. In the United States and abroad, funding for public health research is facing severe contractions. Recent political shifts have led to proposals for massive budget cuts at the National Institutes of Health (NIH), the primary engine of global medical innovation. Furthermore, the dismantling of programs within the U.S. Agency for International Development (USAID) has stripped away support for sexual and reproductive health initiatives that were vital for men and marginalized groups in developing nations. These cuts are not just a domestic issue; they have global repercussions. Infectious diseases do not respect borders, as evidenced by the fact that mpox flare-ups in Africa continue to lead to cases in the U.S., and HIV continues to migrate between different demographic groups.
The path forward requires a fundamental shift in how we view public health. The answer is not to divert resources away from women’s health to fund men’s programs, but rather to recognize that the two are inextricably linked. When men have access to contraception, women’s reproductive autonomy is strengthened. When men are screened and treated for STIs, their partners are protected. To achieve a world where sexual and reproductive health is a reality for all, governments must reinvest in research, double down on scientific breakthroughs, and provide the training necessary for culturally competent, inclusive care. Without a focused effort to include the long-overlooked half of the population, our global health goals will remain forever out of reach. We must invest in men’s health, not just for the sake of men, but for the health and stability of the entire human family.