Background The introduction of the new infectious diseases act in 2000 in Germany abolished compulsory STI-screening of FSW. Since then, the public health office in Cologne has been offering a comprehensive sexual health service for people without access to the regular health care system. Services are provided anonymously and free of charge and are complemented by outreach activities in female sex work venues. The staff is multi-professional and multilingual. We analysed client data to prove effectiveness and range of services.

Methods Since 2002 socio-demographic and clinical data of all clients visiting the counselling and medical services have been inserted in an Access data base. Data of all FSW who used the medical facilities between 2002 and 2012 were analysed using EpiInfo Software.

Results Between 2002 and 2012, 2217 FSW with 83 different nationalities were attended, with a mean of 355 persons per year. Mean age at first consultation was 27.5 years. The percentage of FSW of non-German origin rose from 65% to 87%. In 2002, 36% of migrant woman came from Central Europe, in 2012 72%. Per year, 48% of the patients seen were new, only 12% used the facilities for more than 5 years. In 2002, 41% had no health insurance, whereas 75% in 2012. The proportion of sexworkers tested positive was 12.6% for chlamydia infection, 4.3% for gonorrhoea, 0.9% for syphilis, and 4.3% for trichomoniasis. In 8.5% of FSW, a PAP smear IIID or higher was found. 5 FSW were newly diagnosed with HIV, 3 women were HIV-positive before first contact. At least once, 238 FSW were attended because of a pregnancy.

Conclusions User-friendly non-compulsory sexual health services are used by FSW considered hard-to-reach. Fluctuation is high and sexual health needs go far beyond STI-screening. Comprehensive gynaecological attention and outreach prevention as well as language skills are crucial.