Background: Risk behavior surveys often target sexually transmitted disease (STD) clinic populations, but few studies address risk behaviors in primary care settings. Methods: This cross-sectional study performed at a university adult primary care clinic evaluated risk behaviors using an anonymous, self-administered survey. The following data were collected: demographics, sexual history, condom use, and confidence discussing STDs. Results: A total of 718 surveys were completed: 69% by females and 67% black. A total of 44% had never been asked about sexual health by their primary care provider and 18% reported they had never had a gender-specific genital examination. Among 394 sexually active individuals in the past 3 months, 58% reported never using a condom, and 33% stated they would not use a condom for their next sexual encounter. About one-third of the sample had never been tested for HIV and was not aware of their partner's HIV status. One-third reported history of STD, and 32% reported feeling uncomfortable discussing STDs with primary care provider. Conclusions: Our data demonstrate that sexual health is infrequently addressed despite high rates of previous STDs and low condom use in this population. Identifying barriers to determining sexual risk behaviors in the primary care setting will help to expand testing strategies for HIV and other STDs. Copyright © 2010 American Sexually Transmitted Diseases Association All rights reserved.