Sex workers

Overview

  • Currently, there is no evidence that sex workers in Australia have higher rates of STIs than the general population. Sustaining low STI rates remains a priority.
  • High priority groups include street based sex workers, sex workers who inject drugs, culturally and linguistically diverse sex workers, Aboriginal and Torres Strait Islander sex workers and male and transgender sex workers.
  • There has been widespread adoption of safer sex practice in the Australian sex industry through sex worker advocacy, peer-based education and support and outreach services.

Testing advice

  • Regular testing for STIs and blood-borne viruses is recommended
  • Frequency of testing is guided by risk assessment and may be determined by state-based legislation and guidelines.

InfectionConsideration
Chlamydia Consider 
self-collection of samples for testing.
Gonorrhoea Consider
self-collection of samples for testing.

If NAAT test result is positive, take swab at relevant site(s) for culture, before treatment. Cultures are the preferred test for samples from non-genital sites.

HIV

Repeat test if patient exposed within previous 12 weeks (window period).
Syphilis If clinical suspicion of syphilis, refer to the syphilis  guideline.
Hepatitis A Offer vaccination if susceptible (e.g. MSM sex worker).
Further testing unnecessary after completing vaccination.
Hepatitis B Vaccinate if not immune. Vaccination is free in most states/territories  for sex workers.
Serological testing after completing vaccination is recommended.
Hepatitis C If antibody positive, test for hepatitis C NAAT to determine if patient has chronic hepatitis C.
NAAT – Nucleic Acid Amplification Test
MSM – Men who have sex with men

Specimen collection

Clinician collected
Self-collection 

Clinical indicators for testing

  • Testing for other infections should be considered based on local STI prevalence, symptoms, diagnosed or suspected STI in contact and clinical findings.
  • Recommendations about the frequency of testing can be determined by risk assessment (private and professional life) but may be guided by state-based legislation and guidelines.
  • Offer testing more often if condom use is <100% (including history of condom breakages/slippages) or at the request of the person.
  • If condom breakage/slippage (regardless of whether the male has ejaculated): follow-up within 3 days and offer baseline swab tests and serology. Consider emergency contraception and/or HIV post-exposure prophylaxis (PEP) and/or hepatitis B PEP, as appropriate. Offer repeat swabs in 2 weeks and repeat serology in 3 months (i.e. after appropriate window-periods).
  • It is not recommended to routinely test for herpes and genital warts with serology. Consider testing for herpes and genital warts only if there are clinical signs and symptoms.

Special considerations


Privacy

Ask about the best way to contact with results and reminders. Sexual health clinical services, where a Medicare card is not required, are available in major cities.

Certificate of sexual health check attendance

A ‘certificate of attendance’ or ‘sexual health check certificate’ may be requested by the patient (NB. working name only can be used, at the patient’s request). This is to certify that the patient attended a clinic for tests for STIs only. It should not include examination findings or results and does not provide evidence that there is no infection. A certificate of attendance may reiterate that some infections may not be detectable for weeks or months after infection, if they become detectable at all (eg. herpes and human papilloma virus (HPV)).

Laws

Laws regarding sex work vary between states and territories. Three jurisdictions (ACT, QLD and VIC) have legislation and guidelines which ensure that brothels will only employ sex workers who undergo prescribed tests.

MSM sex workers

For men who have sex with men (MSM) sex workers, test for hepatitis A and offer vaccination if non-immune.

Follow up

If test results are positive, refer to STI management section for advice:

Provide advice about avoiding oral, vaginal and anal sex until no longer infectious (‘exclusion period’). In some jurisdictions, it is an offence for a sex worker to knowingly work during any period when they are known to be infectious with an STI. Advice may be sought from specialist sexual health clinicians.

Contact tracing

‘Provider referral’ may be the preferred method of contact tracing. Advice on provider referral can be sought from the local sexual health clinic or public health unit.

 Even if all test results are negative, use the opportunity to:

  • Educate about condom use and risk minimisation
  • Provide contact details for sex worker organisations e.g. the Scarlet Alliance
  • Vaccinate for hepatitis A and hepatitis B, if susceptible
  • Consider human papillomavirus (HPV) vaccination if under 30 years
  • Discuss and activate reminders for regular testing. State-based requirements and/or risk assessment will guide the frequency of testing.

Auditable outcomes

100% documentation of hepatitis B immunity or vaccination status in current sex workers.

Last Updated: Tuesday, 22 March 2016