Good points. Recognizing the discomfort involved in discussing this face to face, I won't be surprized if in future as knowledge around sex addiction progresses, that addressing STD risks becomes priority. The therapist would not need to know the details or even ask the question, but might simply advize that if the male patient is concerned about STD risks that he would accept to be his Keyholder. Discussing the pros and cons of libido-suppressant medication as van alternative to such a relationship will likely become part of initial contact too before worrying about other factors.