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Sexually Transmitted Infection Testing of Adult Film Performers: Is Disease Being Missed?

Rodriguez-Hart, Cristina MPH*; Chitale, Rohit A. PhD, MPH; Rigg, Robert MD; Goldstein, Binh Y. PhD*; Kerndt, Peter R. MD, MPH*; Tavrow, Paula PhD§

doi: 10.1097/OLQ.0b013e3182716e6e
Original Study

Background Undiagnosed sexually transmitted infections (STIs) may be common in the adult film industry because performers frequently engage in unprotected oral and anal intercourse, STIs are often asymptomatic, and the industry relies on urine-based testing.

Methods Between mid-May and mid-September 2010, a consecutive sample of adult film industry performers recruited from a clinic in Los Angeles, California, that provides medical care to performers was offered oropharyngeal, rectal, and urogenital testing for Gonorrhea, and rectal and urogenital testing for Chlamydia.

Results During the 4-month study period, 168 participants were enrolled: 112 (67%) were female and 56 (33%) were male. Of the 47 (28%) who tested positive for Gonorrhea and/or Chlamydia, 11 (23%) cases would not have been detected through urogenital testing alone. Gonorrhea was the most common STI (42/168; 25%) and the oropharynx the most common site of infection (37/47; 79%). Thirty-five (95%) oropharyngeal and 21 (91%) rectal infections were asymptomatic. Few participants reported using condoms consistently while performing or with their personal sex partners.

Conclusions Adult film industry performers had a high burden of STIs. Undiagnosed asymptomatic rectal and oropharyngeal STIs were common and are likely reservoirs for transmission to sexual partners inside and outside the workplace. Performers should be tested at all anatomical sites irrespective of symptoms, and condom use should be enforced to protect workers in this industry.

A study of multiple anatomical site gonococcal and chlamydial infections among adult film performers revealed a high prevalence of extragenital infections and infections missed by current testing standards.

From the *Sexually Transmitted Disease Program, Division of HIV and STD Program, Los Angeles County Department of Public Health, Los Angeles, CA; †Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ‡West Oaks Urgent Care Center, Canoga Park, CA; and §Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA

We thank the University of California, Los Angeles Bixby Center on Population and Reproductive Health for funding the first author’s research mentorship with the Los Angeles County Department of Health Sexually Transmitted Disease Program.

Conflicts of interest and source of funding: Cristina Rodriguez-Hart received a grant from the University of California, Los Angeles Bixby Center in Population and Reproductive Health to conduct this. The authors have no conflicts of interest to declare.

Correspondence: Cristina Rodriguez-Hart, MPH, Sexually Transmitted Disease Program, Division of HIV and STD Program, Los Angeles County Department of Public Health, 2615 S Grand Ave, Rm 500, Los Angeles, CA 90007. E-mail:

Received for publication July 2, 2012, and accepted August 28, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association