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To Swab or Not to Swab? Infectious Disease Experts Weigh In

Doctors answer questions from PornCrush about polarizing new testing measure

By Austin King / Editor

Mar 9, 2023

One of the most controversial subjects in porn these days isn't a performer, an agency or a production studio.

It's a Q-tip.

Members of the adult industry have discovered that firsthand the past few months, with many studios now requiring talent to add oral and rectal swabs to their panel when testing for chlamydia and gonorrhea.

The increased precaution is in response to an unusual uptick of positive test results that began over the winter and continues to cripple the industry heading into spring.

While many in Porn Valley are accepting and understanding of the additional testing measures, others have expressed skepticism. Some feel the swab tests are unnecessary, almost an overkill. They’ve complained about the additional cost—about $60 every two weeks—they now incur for a test that, until recently, was never deemed important enough to require.

To help answer questions and address concerns performers have about swab tests, PornCrush spoke with two experts in sexually transmitted diseases:

Dr. Jeffrey Klausner is the former Director of STD Prevention and Control Services at the San Francisco Department of Public Heath. While in San Francisco, Dr. Klausner helped identify key factors associated with the increased spread of HIV and STDs and implemented multiple public health prevention programs. Now practicing in Santa Monica, Dr. Klausner gives lectures and attends conferences on STIs both nationally and internationally.

Jamey Bell is a member of the PASS Board of Directors and serves as the Medical Director at the LGBT of Los Angeles. In August, Bell brokered a partnership between PASS and the LGBT Center to provide monkey pox vaccinations to more than 70 sex workers.

PornCrush would like to thank both experts for providing clarity on the polarizing swab issue by answering the following questions:

Should swab tests be a mandatory part of the panel when testing for chlamydia and gonorrhea? Why or why not?

Bell: My take is that they’re absolutely necessary. When I joined the Board of Directors of PASS several years back, that was one of the first things that stood out to me that was really lacking in the panel. I know the leadership at PASS had always known the swabs needed to be included.

In the general population—in this case, the population outside of the LGBT community, sex workers and the adult industry—about 30 percent of chlamydia and gonorrhea is extra-genital, meaning in the throat or rectum. At the LGBT Center, about 50 percent of our cases are extra-genital. You would think the adult industry is somewhere in between or on the higher end of that range. During a urine-only test, we’re ignoring that percentage. We’re going to miss a ton of positives.

Klausner: For this population of people who are working a lot constantly exposing one another to different mucosal surfaces, given that condom use is rare or non-existent, it does behoove people to monitor themselves and make sure they’re not carrying any other infections or anatomic parasites

The interesting thing with STIs … they infect each anatomic site separately. You can have an infection in the throat that’s not going to show up in the urine. You can have an infection in the rectum that’s not going to show up in the blood or urine. The CDC (Center for Disease Control) recommends sexually-active men who have sex with men get three-site testing. You can have a gonorrhea or chlamydia infection at any exposed anatomic site.

Why is it only recommended for men who have sex with men?

Klausner: Oh, Oh, don’t get me wrong. You don’t have to be a male who has sex with men. You can be a male who performs with women only. You could have digital anal penetration, where someone sticks a finger in your anus, and that could occasionally transmit infection.

Remember, chlamydia never shows up in the blood. It’s only on the mucosal surface. So it’s only in the throat, the rectum or the vagina. You can have two sites infected. You can have three sites infected. You could have just the rectum infected. That’s why it’s important - especially in this scenario, with adult films - to have three anatomic sites tested.

Bell: Yes, it’s a common misconception that a negative urine test means you’re completely clear of chlamydia. That’s not the case at all. We have patients and performers who say, ‘I don’t do receptive anal.’ Well, sometimes there are fluids from other areas that get into the general proximity (of the rectum) in various ways.

Again, a lot of people think if they do the urine test, that’s going to tell them if they have gonorrhea or chlamydia anywhere in their body. But it’s really site-specific. You have to test each possible site. Also, some folks think that if they have it in their throat or rectum, that it can transfer to these other sites. That’s not true, unless you are physically transferring it.

If these swab tests are so vital, why did it take PASS and porn studios so long to recommend they become part of the panel? Based on what I’m hearing, I’m a little surprised they haven’t been mandatory all along.

Bell: I completely agree. Sometimes it just takes these kind of situations, these clusters of outbreaks, to bring about change.

Klausner: We had hearings about this with California OSHA (Occupational Safety and Health Association) four or five years ago. And PASS and other industry representatives are fully aware of the importance of the tests.

But the issue has always been, ‘Who is going to pay for it?’ They didn’t want to burden performers with a cost. Performers are somewhat disposable. They’re a dime a dozen. If someone says, ‘I’m not going to perform unless you pay for testing,’ the studio is just going to find someone else.

There’s no empowerment or agency that the performers have. And that’s why I was hoping that California OSHA would try to regulate this area. But people fought hard against regulation. For some occupations, regulation is important to ensure the safety of its workers.

So what do you think should happen?

Klausner: If the industry was serious about protecting its workers, it would have a comprehensive medical safety program that’s paid for by the producers. From my perspective, the people who are making the most money, which are the producers, should be accountable for the health of their employees.

For STI prevention, people should get three-site testing (throat, anus and vagina/penis) along with HIV testing and Hep B and HPV vaccinations. And that’s a cost that should be incurred by the producers.

In many other occupations, that’s a cost taken on by the employer. For example, vests or helmets at a construction site. The workers don’t pay for those, right? But in this industry, because not everyone is an independent contractor, and the producers are just trying to make as much money as possible by exploiting young people. So they’re left with not a lot of power to protect themselves.

Austin King / Editor

Austin King spent nearly 20 years as a mainstream journalist before pivoting to coverage of the adult industry in 2020. He specializes in breaking news and in-depth features, with some of his best work to date coming for AVN Magazine in profiles of Gina Valentina, Casey Kisses, Anna-Claire Clouds, Kayden Kross, Chanel Camryn, Kenzie Anne, Lilly Bell and others. Austin resides in Texas but makes frequent trips to Porn Valley.