title: Unprotected fellatio between female sex workers and their clients in Sydney, Australia.
abstract: OBJECTIVE
  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.
authors.affiliation: Sydney Sexual Health Centre, GPO Box 1614, Sydney, NSW 2001, Australia. phillread@doctors.org.uk
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Read
authors.forename: Handan
authors.initials: H
authors.lastname: Wand
authors.forename: Rebecca
authors.initials: R
authors.lastname: Guy
authors.forename: Basil
authors.initials: B
authors.lastname: Donovan
authors.forename: Anna M
authors.initials: AM
authors.lastname: McNulty
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D010361:Patients; D015995:Prevalence; D060386:Sex Workers; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult