Internet Plays Primary Role in Increase of Early Syphilis Infections Among San Francisco MSM, CDC Reports

The Internet is a "major player" in the increase of early syphilis infections among men who have sex with men in San Francisco, according to a report in the Dec. 19 issue of the CDC's Morbidity and Mortality Weekly Report, Reuters Health reports (Reuters Health, 12/18). San Francisco Department of Public Health researchers analyzed surveillance data and syphilis case reports and examined the link between early syphilis infection and use of the Internet by MSM to meet sex partners. SFDPH researchers interviewed people in the city who had been diagnosed with early syphilis, obtaining demographic data and risk-behavior information for the "period when syphilis might have been acquired or transmitted," which was defined as three months before treatment for primary syphilis, six months before treatment for secondary syphilis and 12 months before treatment for latent syphilis. Patients also received disease intervention counseling, which helped the department locate and treat sex partners (MMWR, 12/19). By 2002, San Francisco had the highest incidence of first-stage and second-stage syphilis of any city in the country, Reuters Health reports. The number of early syphilis cases increased from 41 in 1998 to 495 in 2002. Department officials also noted that an increasing proportion of cases were among MSM; the proportion rose from 22% in 1998 to 88% in 2002. After analyzing data for the 415 MSM diagnosed with early syphilis in 2002, researchers determined that Internet chat rooms and sex partner Web sites were "the most common venues for meeting [sex] partners," according to Reuters Health. Researchers found that 45% of the 151 MSM interviewed had met sex partners online, and approximately 20% of those men "had no other contact information for the partner besides an e-mail address," Reuters Health reports (Reuters Health, 12/18).

Taking Action
The researchers concluded that the findings "underscore the need for public health officials to understand the role of the Internet in facilitating the spread of sexually transmitted diseases, including the human immunodeficiency virus." The researchers said that with the help of community organizations, other cities and localities "can examine the online social/sexual networks that are used commonly in their gay and bisexual communities and develop an effective means of communicating prevention and control messages online" (MMWR, 12/19). Theresa Raphael, executive director of the National Coalition of STD Directors, said, "The Internet has the potential to increase the spread of HIV and STDs, but also has unique characteristics which, if we take advantage of them, can help reduce transmission." She noted that some Internet service providers ask visitors to "disclose their risk behaviors and HIV status to one another by asking them to fill out 'user profiles' for others to see." Raphael said, "These providers have learned that 'don't ask, don't tell' can have serious health consequences. And if ISPs continue to ask, more men will tell" (NCSD release, 12/18).