Background: Long Distance Truck Drivers (LDTDs) and their sexual health risk behaviors have been associated with greater prevalence of sexually transmitted Infections (STIs), HIV and hepatitis virus transmission. However, there is no information about Iranian LDTDs' high-risk behaviors. The aim of this investigation was to estimate the prevalence of high-risk behaviors in Iranian LDTDs. Methods : This cross-sectional study was conducted in Jun 2014 with LDTDs from Tehran Province of Iran. LDTDs were recruited via convenience sampling and given a 43-item reliable and valid questionnaire to assess sexual health risk behaviors and demographic and background characteristics of study participants. Results : A total of 349 LDTDs with the mean age of 36.91 yr (range, 19–65 yr) participated in the study. The average duration of staying away from home for participants was 5 d (SD=±1). Majority of the LDTDs were married (82.2 %) and had more than 5 yr (inclusive) of formal education (95.7%). Younger LDTDs reported more condom use with their partners (r=-0.170, P ≤0.001), more extramarital sexual contacts (r=-0.157, P ≤0.001), more pay for sex (r=-0.110, P ≤0.005) and condom use in their extramarital sex contacts (including with sex workers) (r=-0.176, P ≤0.001). Conclusion : Iranian LDTDs have specific risk factors for unhealthy sexual behaviors. Prevention efforts must emphasize on specific high-risk groups. Keywords : Long distance, Truck driver, High-risk behavior