In some countries, fears about the spread of STDs have prompted the closing of bathhouses—with their private rooms—in favour of sex clubs, in which all sexual activity takes place in the open, and can be observed by monitors whose job it is to enforce safe-sex practices. However, proponents of bathhouses point out that closing these facilities does not prevent people from engaging in unsafe sex.

Neither the claim that bathhouses are responsible for the spread of sexually transmitted diseases, nor the claim that they are not, has been conclusively proved, but it is known that STDs are spread via unprotected sex, and as part of their membership agreement, or as a condition of entry, some bathhouses now require customers to affirm in writing that they will only practice safe sex on the premises, and venues frequently provide free condoms, latex gloves, and lubrication (and/or have them available for purchase). In New Zealand and Australia, the New Zealand AIDS Foundation and constituent members of the Australian Federation of AIDS Organisations provide safe sex information for sex on site venue users.

Some anti-bathhouse activists argue that these measures are not enough, especially given that it is virtually impossible to monitor sexual activity in a bathhouse; however, while they acknowledge that closing gay bathhouses may force some men into unsafe or illegal situations in public parks and lavatories, they point out that they may be less likely to engage in anal or multipartner sex—both of which put participants at risk for contracting STDs—in such situations.

Others counter these claims by pointing out that bathhouses are a major source of safer sex information—they provide pamphlets and post safer sex posters prominently (often on the walls of each room as well as in the common areas), provide free condoms and lubricants, and often require patrons to affirm that they will only have safer sex on the premises. In cities with larger gay populations, STD and HIV testing and counseling may be offered on-site for no charge.