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This paper examines the impact of the U.S. fracking boom on local STI transmission rates and prostitution activity as measured by online prostitution review counts. We first document significant and robust positive effects on gonorrhea rates in fracking counties at the national level. But we find no evidence that fracking increases prostitution when using our national data, suggesting sex work may not be the principal mechanism linking fracking to gonorrhea growth. To explore mechanisms, we then focus on remote, high-fracking production areas that experienced large increases in sex ratios due to male in-migration. For this restricted sample we find enhanced gonorrhea transmission effects and moderate evidence of extensive margin effects on prostitution markets. This study highlights public health concerns relating to economic shocks and occupational conditions that alter the local demographic composition.