Background Adult film industry (AFI) workers engage in prolonged and repeated unprotected oral, vaginal, and anal sex with multiple partners over short periods of time, creating ideal conditions for acquisition and transmission of sexually transmitted infection (STIs). Workers are often required to perform without condoms to maintain employment. Our objective was to estimate the annual cumulative incidence rate of chlamydia (CT) and gonorrhoea (GC), assess the rate of reinfection with CT and GC and describe past HIV outbreaks in the AFI.

Methods CT and GC cases in AFI workers reported to the Los Angeles, California health department surveillance registry between 2004 and 2008 were retrieved. Using 2008 data, CT and GC annual cumulative incidence rates were calculated based on estimates of the worker population. For cases reported between 2004 and 2007, the CT and/or GC reinfection rates within 1 year were determined; all reported HIV cases from 2004 to 2010 were investigated.

Results From 2004 to 2008, 2633 cases were reported among 1849 AFI workers. Lower bounds for the annual cumulative incidence rate of CT and GC among AFI workers were estimated to be 14 300 and 5100 per 100 000 workers, respectively. Reinfection within 1 year was 26%. Female workers were 27% more likely to be reinfected than males (Prevalence Ratio=1.27, 95% CI 1.09 to 1.48). Between 2004 and 2010, 10 HIV cases were reported. In April 2004, 3/14 female workers were infected (attack rate 23%) as a result of workplace exposure. In October of 2010, an acute HIV infection was diagnosed in a male who worked over an 8-week period with 14 performers, including two later found to be HIV infected.

Conclusions CT and GC infection rates among AFI workers are high and repeat infection is common. Transmission of HIV in the workplace has been documented. This industry is not sufficiently regulated to protect workers from serious health risks.