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Unprotected fellatio between female sex workers and their clients in Sydney, Australia
  1. Phillip J Read1,2,
  2. Handan Wand3,
  3. Rebecca Guy3,
  4. Basil Donovan1,3,
  5. Anna M McNulty1,2
  1. 1Sydney Sexual Health Centre, Sydney, New South Wales, Australia
  2. 2School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  3. 3The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Phillip J Read, Sydney Sexual Health Centre, GPO Box 1614, Sydney, NSW 2001, Australia; phillread{at}


Objectives To assess the frequency and predictors of inconsistent condom use for fellatio at work by female sex workers (FSW) in Sydney and the prevalence of pharyngeal gonorrhoea and other sexually transmitted infections in these women.

Methods Cross-sectional study including all FSW attending the Sydney Sexual Health Centre for sexually transmitted infection screening between May 2009 and January 2011 and reporting fellatio at work. Univariate and multivariate regression was used to identify predictors of inconsistent condom use for fellatio.

Results Of 1540 FSW who offered fellatio at work, 372 (25%) reported inconsistent condom use for this fellatio. In multivariate analysis, speaking Mandarin or Cantonese rather than English (adjusted OR (AOR) 2.03, 95% CI 1.44 to 2.86), reporting inconsistent condom use for vaginal sex at work (AOR 10.82, 95% CI 6.13 to 19.09), reporting no vaginal sex at work (AOR 7.48, 95% CI 2.42 to 23.12) and being a new client to the clinic (AOR 2.10, 95% CI 1.56 to 2.83) were associated with inconsistent condom use for fellatio. Thai-speaking women were less likely to report unprotected fellatio (AOR 0.36, 95% CI 0.23 to 0.57). 17 women were diagnosed with pharyngeal gonorrhoea (AOR 1.1%, 95% CI 0.6% to 1.7%).

Conclusions Condom use for fellatio by Sydney FSW varies by work location and language spoken. Health promotion targeting these at-risk women is warranted. Women working in brothels masquerading as massage parlours were particularly likely to report inconsistent condom use for fellatio. Local government reluctance to approve brothels may be contributing to this problem.

  • Prostitution
  • prisoners
  • oral sex
  • lymphogranuloma venereum
  • HIV
  • behavioural science
  • biostatistics
  • epidemiology (clinical)
  • epidemiology (general)
  • bacterial infection
  • prevention
  • primary care
  • STD surveillance
  • STD
  • STD patients
  • STD clinic
  • STD services

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  • Competing interests None.

  • Ethics approval Ethics approval was provided by the SESIAHS-HREC Northern Sector, Sydney, New South Wales.

  • Provenance and peer review Not commissioned; externally peer reviewed.