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Type Accommodation and the title of the report in the subject line of e-mail. Although so-called "virtual sex" carries no risk for transmission of sexually transmitted diseases STDsincluding human immunodeficiency virus HIVuse of the Internet to find partners for actual sexual activity does carry such risk 2.
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Because the Internet enables sex partners to maintain anonymity by withholding identifying information e. Use of the Internet by public health authorities to notify sex partners of persons with STDs has been reported ly 2.
This report describes two cases in Los Angeles County LACCalifornia, in which public health officials used the Internet to notify partners who were otherwise anonymous. Local public health authorities might develop similar strategies to use the Internet to reduce transmission of STDs.
Subsequent interviews with DIS personnel were conducted to determine the degree of partner follow-up and testing. Case Reports Case 1.
In Decemberan LAC resident aged 32 years visited his physician for a routine follow-up of his HIV infection, which was diagnosed in The patient had a rash and reported influenza-like symptoms 1 week before and subsequently tested positive for syphilis. The patient reported male sex partners, all of whom he met via the Internet during a 6-month period; 29 were repeat sex partners. He also stated that he never used condoms.
The index patient provided e-mail addresses and 23 telephone s nessage facilitate contact tracing and sex partner notification. First and last names were provided for eight contacts.
LACDHS sent an e-mail message ,os all sex partners, alerting them to an urgent health matter and requesting that they call the telephone provided as soon as possible. The message concluded with a confidentiality notice. Case 2. In Januaryan LAC resident aged 31 years sought medical attention at an emergency department after noticing a rash on his body.
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He received a diagnosis of scabies and was administered treatment; most of the rash resolved. He was asked to send his contacts an e-mail message about his infection. Subsequently, he provided LACDHS with 16 e-mail addresses and copies of 13 e-mail messages that he had sent to his sex partners, notifying them of their mmessage to syphilis and the health department's efforts to contact them. Seven of the 13 persons replied and made arrangements to be tested for syphilis.
Editorial Note: Partner notification is a process whereby sex partners of patients index patients who have an STD or HIV diagnosed are informed of their exposure to infection and the need to seek medical evaluation 4.
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Usually these goals are accomplished by provider referral or patient referral. Provider referral is a confidential process by which public health authorities request names and identifying information about sex partners from the index patient to notify those persons of their exposure. Patient referral is a process by which partners are notified by the index patient without the assistance of public health personnel.
These methods have changed little since the s.
As the cases described in this report indicate, the Internet presents new challenges and opportunities for STD and HIV prevention and control. Using the Internet to meet sex partners can be a sexual risk-taking behavior 3,5.
Persons seeking testing at a municipal HIV-counseling and -testing site who sought Internet sex partners reported a high level of sexual risk-taking behavior; compared with non-Internet sex seekers, Internet sex seekers were more likely to be MSM and to messaeg more STDs, more partners, more anal sex, and more sexual exposure to partners known to be HIV-positive 3. In a case involving seven persons with syphilis who met through an Internet chat room, the local health department worked with a marketing firm to enter the Internet chat room and send electronic messages to hundreds of users about the syphilis cluster 5.
A case-control study demonstrated a statistically ificant association jessage Internet use and acquisition of syphilis in this population 5. The cases described in this report indicate that public health departments can use the same technology that facilitates dissemination of STDs to prevent and control STDs. In addition, case 2 indicates that involvement of the index patient in partner notification via e-mail can improve partner response rates.
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In a separate evaluation of instant messaging i. Further study is needed to determine the most effective method of using the Internet as a means of partner notification and evaluation. However, personalized messages, messages sent from an e-mail provider or within an Internet service provider ISPand message headers referencing a health matter might be more likely to be read than angeels messages angeled are not personalized or do not reference a specific health matter K.
The same confidentiality rules apply to messages sent online as to those sent via telephone or mail; for this reason, discreet, urgent messages are most effective. Although online referral makes ensuring the confidentiality of the contact more difficult, it is an efficient method for establishing initial contact with an otherwise inaccessible person and allows subsequent communication to occur.
Public health authorities should develop strategies to use the Internet to reduce transmission of STDs.
Frequently asked questions
Suggested practices for online partner notification have been published 2. Other strategies include 1 providing health education and prevention messages on ahgeles that are frequently visited by MSM mssage pop-up and links to websites offering information on STD-testing sites, STDs, and partner referral; 2 making health educators available in chat rooms to answer health-related questions; and 3 offering online test-result reporting, which might increase testing for HIV and STDs by preserving anonymity and decreasing the lag period from test to result.
Sex and cyberspacevirtual networks leading to high-risk sex.
JAMA ; Internet use and early syphilis infection among men who have sex with menSan Francisco, California, MMWR ; The Internet as a newly emerging risk environment for sexually transmitted diseases. Angelfs ; Tracing a syphilis outbreak through cyberspace.
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