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STD Risks to Performers in the Adult Film Industry

STD Risks to Performers in the Adult Film Industry



Katherine M. Stone, MD

Katherine M. Stone, MD
Medical Epidemiologist Atlanta, GA
Presented at AFI Think Tank
October 27, 2006



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  • Good morning. I’d like to thank Drs. Tavrow and Kerndt for inviting me here. This morning I will try to briefly summarize the various STDs and how they are spread.
  • Why do we care about STD? First of all, they are very common and most are preventable by condom use. But almost all of them are silent – they cause no symptoms and people don’t know they’re infected unless they get screened. If not treated early, STDs can have serious, sometimes fatal, consequences, and also many STDs increase the risk of HIV.
  • Here is a more detailed list of consequences, including infertility, several types of cancer, and neonatal infection that can be fatal.
  • Some STDs are spread ONLY when infectious anogenital fluids contact a partner’s mucous membranes. Fluids include pre-ejaculate, semen, and penile discharge and cervical/vaginal or anorectal secretions. Mucous membranes include the urethra, cervix, vagina, anus, rectum, mouth, throat, and eye. These can be spread during vaginal, anal, or oral sex and probably by sharing sex toys. The list includes chlamydia, gonorrhea, HIV, hepatitis B and C, trichomoniasis, and bacterial vaginosis. HIV, HBV, and HCV are also be spread by contact with blood. All of these are easily preventable by condoms.
  • Other STDs are spread when infected skin or mucous membrane directly contacts a partner’s skin or mucous membrane INCLUDING NONGENITAL SKIN, and can be spread by vaginal, anal, or oral contact even without penetration, and perhaps also by shared sex toys. HSV and HPV can also be in anogenital fluids, and syphilis bacteria can also be present in blood. Most, but not all, are preventable by condoms. I say “most” because the majority of infections in males involves the head and shaft of the penis - areas that would be covered by a condom.
  • Here are the STDs that can infect the throat or mouth, and the ones that can cause eye infections. Gonorrhea infections of the throat and eye can be difficult to treat. Gonorrhea and HSV eye infections can be serious and can cause loss of vision.
  • There’s a 3 rd category - infections usually spread by contaminated food or water, also called “fecal-oral” transmission. These can be spread during sex if feces or anal fluids somehow find their way to a partner’s mouth, either directly by anilingus or indirectly on a contaminated penis or finger. These infections cause diarrhea and are called enteric infections; the list is longer, but here are some common ones.
  • Some STDs are very infectious, and transmission is likely even with just one act of intercourse. These numbers are from studies of vaginal sex. For HSV and HIV, risk of transmission is higher from people with NEW infections, and, for HIV, from those with high viral loads. Also, transmission during anal sex is likely to be higher.
  • Sex practices in the adult film industry generally pose increased risk, including multiple partners over short time periods, prolonged intercourse that may result in inadequate lubrication and anogenital trauma or bleeding, and also protective equipment such as condoms and lubricants are often not readily available.
  • This slide shows best estimates of numbers of cases of chlamydia, gonorrhea, and syphilis as determined by the LACHD STD Program. This is believed to underestimate the actual number, as screening of STD is not done for all STDs and is likely to be incomplete among performers, especially for the earlier years. Data for 2006 is through October 15 th (does not reflect a decline compared to 2005).
  • While screening is a very important public health activity, it does not prevent infection in an individual. The purpose of screening is to identify infected persons so they can be treated promptly to prevent complications and halt further spread to sex partners.
  • This table shows the STDs that are curable by antibiotics. However, in recent years gonorrhea in California has become resistant to commonly used antibiotics, vastly limiting the options for oral treatment. Most of these are preventable by condoms.
  • STDs caused by viruses are not curable with antibiotics or antiviral drugs, but they are treatable. Note for HPV, there’s no treatment for the virus but the diseases it causes are treatable. HIV, HSV, and usually HCV persist lifelong, whereas the others are usually cleared by the body’s immune system but a small percentage of HBV persists lifelong. Most are preventable by condoms. Note also that safe and effective vaccines are available for Hepatitis A and B, and HPV.
  • In conclusion, let me emphasize that risks for STD including HIV can be very high, they can have serious consequences, and most transmission is preventable by condoms. Thank you very much.

STD Risks to Performers in the Adult Film Industry STD Risks to Performers in the Adult Film Industry Presentation Transcript

  • STD Risks to Performers in the Adult Film Industry Katherine M. Stone, MD Medical Epidemiologist Atlanta, GA October 27, 2006 UCLA Think Tank
  • STD Risks to AFI Performers Importance of STD  Common  Preventable by condoms  Almost all are “silent”  no symptoms  identified by screening  Serious consequences  Some are fatal  STDs increase risk of HIV
  • STD Risks to AFI Performers Importance of STD Serious consequences AIDS; often fatal Increased risk of HIV Neonatal infection Cervical, penile, anal cancer Neonatal infection Liver disease, liver cancer Neonatal infection Chlamydia Gonorrhea Trichomoniasis (Trich) Bacterial vaginosis (BV) HIV Hepatitis B virus (HBV) Hepatitis C virus (HCV) Syphilis Herpes simplex virus (HSV) Human papillomavirus (HPV) Increased risk of HIV PID, infertility Pregnancy complications Neonatal infection
  • STD Risks to AFI Performers STDs spread by fluids to mucous membranes  Contact of FLUIDS (pre-ejaculate, semen, penile discharge, cervical/vaginal or anorectal secretions) with MUCOUS MEMBRANES - urethra, cervix/vagina, anus/rectum, mouth/throat, eye  Vaginal, anal, oral sex  Shared sex toys  STDs include:  Chlamydia  Gonorrhea  HIV  Hepatitis B (HBV)  Hepatitis C (HCV)  Trichomoniasis  Bacterial vaginosis (BV)  Easily preventable by condoms }also in blood
  • STD Risks to AFI Performers STDs spread “skin to skin” Spread by contact of infected skin/mucous membrane with partner’s skin/mucous membrane  Vaginal, anal, oral contact  Shared sex toys STDs include:  Herpes simplex virus (HSV)  Human papillomavirus (HPV)  Syphilis Preventable by condoms }also in fluids - also can be in blood (sometimes NONGENITAL skin)
  • STD Risks to AFI Performers  Chlamydia  Gonorrhea  HSV  Syphilis  HIV STDs transmissible to eye  Chlamydia  Gonorrhea  HSV STDs spread by fellatio
  • STD Risks to AFI Performers STDs spread by “fecal-oral” contact  Usually transmitted by contaminated food or water; CAN be transmitted sexually through:  Anilingus  Fellatio immediately after anal sex  Oral contact with sex toys immediately after anal contact  Sexually transmitted enteric infections include:  Hepatitis A (HAV)  Entamoeba histolytica  Giardia lamblia  Shigella  Salmonella  Cryptosporidium  Campylobacter
  • STD Risks to AFI Performers Gonorrhea: 20-90% Chlamydia: 45% HPV: 40% HSV: 0.05 - 0.2% HIV: 0.05% - 20% Estimated risk of infection from 1 vaginal sex act with an infected partner
  • STD Risks to AFI Performers  Multiple partners over short time periods  increases risk of STD/HIV  increases potential for rapid spread  Prolonged intercourse  inadequate lubrication  anogenital trauma, bleeding  Lack of protective equipment  Condoms, dental dams/barriers, lubricants General AFI practices increase risk:
  • Number of Reported STDs by Year AFI Performers 2000 – 10/2006 26 38 70 295 428 425 270 9 9 35 168 203 371 302 1 2 6 3 1 1 1 0 50 100 150 200 250 300 350 400 450 2000 2001 2002 2003 2004 2005 2006* Year Numbers Chlamydia Gonorrhea Syphilis *through Oct. 15
  • STD Risks to AFI Performers  Does not prevent infection  Allows prompt identification and treatment of infected persons  Prevents consequences of infections  Prevents further spread to sex partners Screening
  • STD Risks to AFI Performers Curable STDs Preventable by condoms Screening available Chlamydia + + Gonorrhea + + Syphilis + + Trichomoniasis + + BV ? + Enteric infections _ _
  • STD Risks to AFI Performers Incurable STDs Treatable Persists lifelong Preventable by condoms Screening available HIV + + + + HSV + + + + HCV + 55-85% + + HBV + 6% + + HAV + _ _ + HPV _ _ + + * * women only v vaccine-preventable V V V
  • STD Risks to AFI Performers Conclusions  Risks for STDs including HIV are high  STD/HIV can have serious consequences  Most STD/HIV transmission is preventable by condoms