Sexual health
Free on the NHS, and the guidance for this work is specific rather than general. What BASHH actually recommends.
Sexual health services are free on the NHS across the United Kingdom, and the clinical guidance for people doing this work is specific rather than general. It is worth following properly.
How often to test
The British Association for Sexual Health and HIV publishes clinical standards for the sexual health management of people involved in sex work. Its recommendation is routine testing every three months for anyone offering services involving direct sexual contact or exposure to body fluids.
The panel it recommends is wider than a standard screen:
- Chlamydia and gonorrhoeaTriple-site testing: throat, rectum and urethral or urine sample. Single-site testing misses a substantial share of infections.
- HIV and syphilisBlood tests, at each three-monthly screen.
- Hepatitis BAt the first visit, repeated if there is no immunity, and again six weeks after vaccination. Vaccination is recommended for everyone involved in sex work.
- Hepatitis CAt the first visit, then every three to six months where risk continues.
Where to go
Sexual health clinics, still widely called GUM clinics, provide free testing, treatment, contraception and condoms. Clinic finders are published by the NHS at nhs.uk. Testing does not require a GP referral, and postal testing kits are available in many areas for routine screens between clinic visits.
Telling a clinician about the work is worth doing. It changes what is offered: the three-monthly interval, triple-site swabs, vaccination and PrEP are all easier to arrange once the reason is on the record, and sexual health services are used to the conversation.
PrEP
Pre-exposure prophylaxis is medication taken to prevent HIV infection. BASHH's standard is that PrEP should be offered to any sex worker potentially or currently offering services that carry a risk of HIV acquisition.
| Nation | Position |
|---|---|
| England | Free on the NHS, routinely commissioned since October 2020 and delivered through local sexual health clinics |
| Scotland | Free through NHS Scotland sexual health services, available since 2017 |
| Wales | Free through NHS Wales sexual health services across all health boards, available since 2018 |
| Northern Ireland | Offered at all GUM clinics, with eligibility assessed by a clinician |
Vaccination
Hepatitis B vaccination is recommended for everyone in sex work. Hepatitis A vaccination is considered for those at increased risk, including anyone providing unprotected oral-anal contact. HPV vaccination is available on the NHS to male and transgender sex workers.
Condoms
Free from sexual health clinics in quantity, which removes any argument about cost. Carrying more than expected to be needed is standard practice, as is treating their use as settled rather than negotiable. A client who raises the subject during a booking has told the escort something useful about how he treats other people, and declining at that point is reasonable.
What agencies ask for
Most listing operations ask for recent negative STI and HIV results at intake and expect testing to continue while a profile is active. That is a condition of the listing rather than a legal requirement, and it is a condition worth welcoming: it is the mechanism that keeps the standard across a directory rather than leaving it to individuals.
If something is found
Most sexually transmitted infections are curable and the rest are manageable. The practical points are to stop working until treatment is complete and the clinic confirms it is safe to resume, to follow the partner notification process the clinic offers, and to tell the agency if one is involved. Clinics handle partner notification anonymously as a matter of routine.
This page summarises published NHS and BASHH guidance and is not medical advice. Anything specific belongs with a clinician, and sexual health services are free, used to this work and not in the business of judging it.