Engagement in sexual healthcare and STI/HIV burden of first- and second-generation migrant and Western-born female sex workers in the Netherlands: A retrospective cohort study

•Largest cohort study examining migrant FSW STI burden and healthcare engagement.•Migrant FSW have higher burden and odds of infectious syphilis, hepatitis B, and HIV.•Western-born FSW have higher burden of CT and NG than first-generation FSW.•First-generation migrants less likely to have a repeat consultation versus Western-born.•Targeted outreach needed in STI clinics to improve migrant FSW healthcare retention. Scarcely available European studies suggest that migrant female sex workers (FSW) have a higher likelihood of sexually transmitted infections (STI) but a lower likelihood of HIV compared to non-migrant FSW. This study assessed demographics, STI/HIV burden, and engagement in sexual healthcare among first-generation (FGM) and second-generation (SGM) migrant FSW versus Western-born FSW. This large retrospective cohort study included 27,532 Dutch STI clinic consultations from 11,363 individual FSW between 2016 and 2021. STI diagnoses (chlamydia/gonorrhoea/ infectious syphilis/infectious hepatitis B/HIV) in the first consultation were compared using Chi-squared test. Logistic regression adjusting for age, urbanity and sexual behaviour assessed associations between migration status and STI diagnoses. Incidence of repeat consultation was compared between migration groups using Cox proportional hazards regression, adjusting for age and STI clinic urbanity. FGM FSW (n = 5085) mostly originated from Eastern Europe (50.5 %) and SGM FSW (n = 1309) from Suriname/Netherlands Antilles (36.3 %). Among FGM, SGM and Western-born FSW, 11.4 %, 15.2 % and 13.3 %, respectively (p < 0.001) were diagnosed with any STI. FGM FSW had a lower odds (aOR 0.78, 95 %:CI 0.65–0.94,p < 0.01) of chlamydia or gonorrhoea diagnosis, but a higher aOR (6.38,95 %CI:2.63–15.49,p < 0.001) of HIV, syphilis, or hepatitis B diagnosis in the first consultation. FGM FSW had a lower likelihood of a repeat consultation at any time (aHR:0.73,95 %CI:0.69–0.77,p < 0.001) than Western-born FSW. Migrant FSW versus Western-born FSW demonstrated a varying burden of STI, FGM heightened proportions and odds of infectious syphilis, hepatitis B and HIV and lower likelihood of repeat consultations. Enhancing accessibility and outreach efforts for migrant FSW in sexual healthcare services is imperative.