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Health care considerations for sex workers

Health care considerations for sex workers
Clinical considerations Comments
Cancer screening
  • Routine screening is performed for all cancers including those related to HPV (eg, cervical cancer screening).
Contraception
  • Provide information about contraception as indicated; the choice of contraceptive method is highly individualized and should be tailored to the individual's needs.
Documentation
  • In settings where sex work is legal, a health check certificate may be requested by the patient.
  • In settings where sex work is illegal, documentation of sex work may warrant special consideration.
HIV PEP and PrEP
  • Discuss PEP if a patient has a known or presumed exposure to HIV within the last 72 hours.
  • Discuss PrEP if the patient has ongoing risks of HIV exposure.
Immunizations
  • Review immunization history. In particular, ensure appropriate vaccination for*:
    • HAV
    • HBV
    • HPV
STIs
  • STI screening:
    • Chlamydia
    • Gonorrhea
    • Syphilis
    • Trichomonas (for those with a vagina)
    • HIV
    • HCV
    • HBV (vaccinate if not immune)
  • The frequency of such screening depends on the assessed risk of exposure.
  • Routine screening for herpes and/or genital warts is not performed (these are clinical diagnoses).
  • STI prevention:
    • Encourage male condom useΔ.
    • Discuss PEP with doxycycline for selected individuals◊.
Trauma, substance use, and mental health
  • Regular screening for interpersonal violence, other trauma, and sex trafficking.
  • Increased frequency of screening for substance use and mental health issues.
  • Increased awareness of stigma encountered in medical care settings (especially in settings where sex work is criminalized).
Sex workers, a term used to describe individuals who engage in sexual activity in exchange for money, material goods, or other services, are often not identified in the health care setting. However, such individuals may have specific healthcare needs; some of these considerations are included in this table.

HAV: hepatitis A virus; HBV: hepatitis B virus; HCV: hepatitis C virus; HIV: human immunodeficiency virus; HPV: human papillomavirus; PEP: postexposure prophylaxis; PrEP: pre-exposure prophylaxis; STIs: sexually transmitted infections.

* Other immunizations (eg, mpox vaccine) may be warranted in selected populations. Refer to related UpToDate content.

¶ In some locations where safer sex practices are commonplace among sex workers (through sex worker advocacy, peer-based education, support, and outreach services), rates of STIs among sex workers are similar to that of the general population. In such settings, annual screening may be reasonable. More frequent testing may be warranted in selected individuals (eg, individual prefers/requests more frequent testing, condom breaks, residing in a country with no/little safe sex practices among sex workers or where the legal status of sex work results in a lower likelihood of medical care).

Δ Condoms lubricated with spermicides are no more effective than other lubricated condoms in protecting against the transmission of HIV and other STIs.

◊ PEP with doxycycline can reduce the incidence of syphilis and chlamydia in selected populations. Refer to related UpToDate content.

Prepared with information from:
  1. Sex workers. Australian STI Management Guidelines for Use in Primary Care. https://sti.guidelines.org.au/populations-and-situations/sex-workers/ (Accessed on February 13, 2025).
  2. Recommendations for evaluating donor eligibility using individual risk-based questions to reduce the risk of human immunodeficiency virus transmission by blood and blood products. US Food and Drug Administration. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/recommendations-evaluating-donor-eligibility-using-individual-risk-based-questions-reduce-risk-human (Accessed on February 13, 2025).
  3. McCann J, Crawford G, Hallett J. Sex Worker Health Outcomes in High-Income Countries of Varied Regulatory Environments: A Systematic Review. Int J Environ Res Public Health 2021; 18:3956.
  4. American College of Obstetricians and Gynecologists. Improving awareness of and screening for health risks among sex workers. Committee Opinion No. 708. Obstet Gynecol 2017; 130:e53.

The editors of UpToDate would like to thank Jennefer Russo, MD, for her assistance in creating this table.

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