Check-up from 35: what gay men should include

Throat, rectum, urine, blood. If you're on PrEP, you know the quarterly swabs and could recite the routine in your sleep. Then your GP asks about your last cholesterol reading, and there's silence.

For many men on PrEP, sexual health is better organised than anything else. From 35, it's worth bringing the two together. In Germany the check-up is covered by statutory health insurance, so access is rarely the problem. The list is: say just “a full check-up, please” and you get the standard. It's solid, but there are a few points you need to put on the table yourself.

What insurance covers from 35

From 35, people with statutory insurance are entitled to a health check every three years, usually called Check-up 35 in practices. Between 18 and 34, you get it once. It includes:

• a conversation about previous illnesses, family history and lifestyle
• a physical examination and blood pressure measurement
• blood tests: cholesterol, triglycerides, blood sugar
• a urine test
• a vaccination status check
• a one-off test for hepatitis B and C

Separately, from 35 insurance covers skin cancer screening every two years: head to toe, including the spots you never get to see yourself. Many GP practices offer it too, otherwise a dermatologist. Both fit into one morning. Arrive fasted, give blood, undress once.

In Austria and Switzerland, screening and coverage are organised differently. The topics on the list stay the same.

Vaccinations: the record in the drawer

Vaccination status is officially part of the check-up, but in everyday practice the conversation often ends at tetanus. For men with male partners, a few other recommendations from Germany's Standing Committee on Vaccination (STIKO) are more relevant.

Hepatitis A and B

Hepatitis A is transmitted through tiny traces of faeces, hepatitis B through blood and other bodily fluids. Both routes play a role in your intimate life. STIKO recommends both vaccines where sexual behaviour increases the risk of infection, and insurance usually covers the cost. There's a combined vaccine for both. If you were vaccinated against hepatitis B as a child, you can have your protection checked via your anti-HBs antibody level.

HPV

Human papillomaviruses are very common and mostly harmless. Some types cause genital warts, others can lead to cancer over years, including in the anal area. STIKO recommends the vaccine as standard for 9- to 14-year-olds, with catch-up possible until 17. There's no general recommendation for adults. It can still make sense, because it protects against the types you haven't been infected with yet. Some insurers pay voluntarily; a phone call will tell you.

Mpox

Since 2022, STIKO has recommended the mpox vaccine for men with frequently changing male partners. Two doses at least 28 days apart, and insurance covers the cost. If you only got one dose back then, get the second.

The exam hardly anyone asks about

Anal cancer is rare. But in men with male partners it's significantly more common than average, especially with HIV, and HPV is usually behind it.

There's no insurance-funded screening programme for it. For men with HIV, guidelines recommend regular examinations; everyone else is best off raising it themselves. A manual exam takes a minute. For blood, itching, lumps or pain that doesn't go away on its own, proctology is the right place. Haemorrhoids are common, but not everything that looks like one is one. The appointment is shorter than the hesitation before it.

Then there are tests for sexually transmitted infections. On PrEP, they happen every three months anyway. Without PrEP but with changing partners, the same principle applies: test regularly, and at the sites where there was contact. A urine test alone won't find an infection in the throat or rectum.

Where to take the list

The check-up and skin cancer screening belong with your GP. How far you get there with the rest depends on how openly you can talk. If the honest answer is “not really”, find another practice rather than dropping topics. Many cities have HIV specialist practices that hear these questions every day, including from men without HIV.

The second address is the Checkpoints, usually run by the Aidshilfen. They offer anonymous testing for HIV and other sexually transmitted infections, often free or for a small fee, plus advice on vaccinations.

For the note in your jacket pocket: check-up, skin check, vaccination record, hepatitis status, HPV, mpox, STI tests at all sites, the question about an anal exam. One morning, a few phone calls. Which of these make sense for you is something to discuss with your doctor.