Sexwork and STDs: Understanding risks and protecting yourself

Sexually transmitted diseases (STDs) are a significant concern among sex workers and their clients. Worldwide, sex workers tend to have a higher incidence of STDs than non-sex workers [1], however factors such as socioeconomic status, geographic location, prostitution’s legal status, and where sex work takes place (eg. Indoor versus street-based) are some of the factors that impact this.

Nonetheless, it’s critical that people do everything they can to protect themselves from STDs by practicing safe sex practices – unless you want to be part of that statistic that sees STD cases on the rise [2]. Unfortunately, some sex workers and clients believe that contracting a disease can’t happen to them. In my time as an escort, I’ve heard all the excuses:

“I’m clean.”

“I’m a white male.”

“I usually use condoms, but…”

“I’ll pay extra.”

“If I give you my testing can we have BBFS [bare-back full service, ie. Unsafe sex]?”

“I don’t do this very often.”

The last one is a riot. Research by Monto and Milrod (2014) showed some interesting numbers between Internet Hobbyists (defined as men who solicited sex online from the well-known review site The Erotic Review, TER) and their non-customer counterparts:

This table shows the percentage  of new sexual partners between non customers and Internet hobbyists. Data in percentage (%), adapted from [3].

Sex workers can sometimes feel pressured into performing unsafe services. Clients threaten bad reviews, claim they won’t book, or tout “But the other girl I saw did it…” Some escorts have even reported “stealthing” by clients, where the client takes the condom off without the escort knowing. Then there are the sex workers who are knowingly, but discreetly, offering BBFS to clients, putting us all at risk. Attitudes like these make it that much harder for those of us who want to protect our clients and ourselves.

Understanding Disease Transmission

Understanding disease transmission requires knowing not only vectors and methods, but also understanding the impact social networks can have. We know STDs are transmitted during various forms of sexual activity, by skin to skin contact or fluid exchange, particularly when a person is contagious, or in the case of HIV, has a high viral load.

But what many people don’t get is the effect that being in a particular social network has on spreading diseases. A social network is a group of people all connected in some way – in our case, it’s sex workers and their clients. Geographically, these networks may span over large or small areas, and contain many or few people. Network density refers to the overall connectedness within the network, and is an indication of how often people have sexual interactions with each other. You can have the same number of people in a given area, but if only a few of them have sex with each other, the density is lower; by contrast, if many of them have frequent sexual contact with each other, then the density is higher. There’s a reason people of specific populations have higher disease rates than others; it’s not just the disease, it’s the network they’re in and how disease is spread around the network [4].

In the case of sex workers and clients, local communities tend to be rather small. There may be only a few hundred to a few thousand individuals, and you can imagine that if one person gets something and it goes unchecked, it can spread quite quickly. This was the case with Patient 0 in the AIDS epidemic of the 1980s. Patient 0 was able to spread AIDS quickly due to his large network spread over a number of geographic areas [5].

This brings us to the topic of travel. Many escorts travel on tour, and many clients use escort services while travelling for work or pleasure. This brings its own set of risks, because, like Patient 0, you may be carrying a STD to various places and spreading it around. Travel is actually a significant risk factor for contracting an STD [6].

For some reason people understand this when it comes to things like the Zika virus or Ebola, but they’re clueless when it comes to STDs. I don’t get it.

Protecting Yourself

I’m not going to go into a long list of associated diseases and their symptoms. There are far better resources on the Internet than what I can give you. You can check some of them out here:

Centers for Disease Control

Health Canada

Planned Parenthood

Medicine Net– with pictures!

Sex and U

What I will say is that most STDs don’t give any warning, and many don’t know they’re infected. It still blows my mind that people can plead ignorance to these things and not do anything about it. Do yourself – and everyone you have sex with – a favor and go get tested.


Here’s where you’ll get a modicum of sympathy from me. Sometimes it can be hard to access testing, depending on your situation. There’s a stigma attached to sex work, and clients who have partners may be afraid of getting tested using their primary care physician. I’ve put together a list of resources for those who are a little gun shy on getting checked. It’s not a comprehensive list, but it’s helpful for those in North America. When in doubt, Google is your friend.

Hassel Free Clinic– Toronto

Toronto Public Health

Find a Clinic– Sexual Health Ontario

Smart Sex Resource– British Columbia– United States

GetTested – CDC– United States

Planned Parenthood– United States


Online testing is moving into the future and offers a convenient way for you to get STD testing without leaving your home or office. You collect your sample and mail it in. While it’s discreet and convenient, although it can take a couple weeks to get back results. Here are some options for you.

Let’s Get Checked – Offers testing to 30 countries in North America, Europe and the UAE.

myLab Box – Currently only shipping to US addresses.


We live in this big, modern, magical world where literally anything is at our fingertips. There’s no excuse not to protect yourself and others, and take care of those you love in getting yourself tested. Do everyone a favor and take care of your health.



[1] Cwikel et al. (2008). Sex Health, 5: 9-16.


[3] Monto & Milrod (2004). Int J Offender Ther Comp Criminol, 58: 802-820.

[4] Doherty et al. (2005). J Infec Dis, 191:S42-54.

[5] Klovdahl (1985). Soc Sci Med, 21: 203-216.

[6] Avery & Zenilman (2015). Microbiol Spectrum, 3: 1-13.

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