Intended for healthcare professionals

Clinical Review

Caring for sex workers

BMJ 2015; 351 doi: (Published 05 August 2015) Cite this as: BMJ 2015;351:h4011
  1. Michael L Rekart, clinical professor
  1. 1School of Population and Public Health, University of British Columbia, Vancouver, BC Canada V6T 1Z3
  1. Michael.rekart{at}

The bottom line

  • Ensure vaccinations are up to date (diphtheria-tetanus (DT), measles-mumps-rubella (MMR), meningococcal, influenza, hepatitis A, hepatitis, B and human papillomavirus)

  • Provide regular screening and management for sexually transmitted infections, HIV infection, cervical and anogenital cancer, hepatitis B and C viruses, tuberculosis, and drug, alcohol, and tobacco dependence

  • Improve reproductive health by means of dual contraception, safe abortion, and emergency oral contraception

  • Prevent HIV, sexually transmitted, and blood-borne infections via pre-exposure prophylaxis, post-exposure prophylaxis, condoms, lubricant, needle-syringe exchange programmes, and male circumcision

  • Expedite sexual assault survivor services

  • Ensure comprehensive mental and transgender health care

Sex workers are adults who receive money or goods for sexual services, either regularly or occasionally,1 including female, male, and transgendered sex workers.2 3 Youths under 18 years who sell sex are sexually exploited and not included in the definition.

Caring for sex workers seeking health services requires knowledge, flexibility, open mindedness, and, above all, a non-judgmental attitude. Practitioners can be directly involved in curing communicable diseases, preventing chronic conditions, and helping patients through a sometimes difficult period. Sex workers are at higher risk of many conditions (box 1), but they may also have ongoing chronic disease issues. This article provides an evidence based review (see box 2 for details of data search) of the specific health needs of sex workers, aimed at non-specialist hospital doctors, general practitioners, and candidates for postgraduate examinations globally.

Box 1: Health issues for sex workers

  • HIV infection—Evidence from systematic reviews and meta-analyses4 5 6 7

  • Sexually transmitted infections (gonorrhoea, chlamydia, syphilis, herpes (HSV-2), trichomonas, human papillomavirus)—Evidence from analytical and observational studies2 8 9 10 11 12 13 14 15 16 17

  • Complications of sexually transmitted infections (pelvic inflammatory disease and ectopic pregnancy)—Evidence from analytical and observational studies2 8 9 10 11 12 13 14 15 16 17

  • Hepatitis A, B, and C—Evidence from observational …

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