Use of the Internet as a public health intervention tool for an outbreak of syphilis

A recent study of a syphilis outbreak amongst homosexual men in San Francisco showed a significant association between the use of the Internet as a means for meeting sexual partners and acquiring syphilis (Journal of the American Medical Association, 2000, 284: 447–449). In a case–control study, infected individuals were almost four times as likely to have met their sexual partners in an Internet chat room, an electronic forum which allows the exchange of messages via computer, compared to a non-infected control group of homosexual men who presented to a clinic.

The study highlights some important points that need to be considered for public health interventions amongst risk groups with access to the Internet. Since the outbreak occurred amongst homosexual men who met their partners through a chat room partner information was in most cases limited to fictitious ‘‘screen names’’. For potential legal and privacy reasons, the Internet Service Provider refused to release the names of the individuals using the chat room without a legal order. To circumvent this, an awareness campaign was initiated with the cooperation of the Internet Service Provider.

For two weeks, a San Francisco marketing firm accessed the chat room by sending electronic messages giving advice to persons with sexual contacts to seek medical evaluation. The San Francisco Department of Public Health also sent messages to the screen names to notify partners of their possible exposure to syphilis. The syphilis control efforts during late July 1999 resulted in an 18% increase in the number of homosexual men evaluated at the San Francisco Department of Public Health City Clinic in early August compared to the month of July. Seventy one per cent of individuals who responded to a questionnaire thought that the awareness campaign was appropriate.

Dr Jeffrey Klausner, head of the Sexually Transmitted Diseases Unit of the San Francisco Department of Health and one of the coauthors of the study, informed the Bulletin: ‘‘The Internet has become a valuable source of information on health and disease for individuals and a new opportunity for health promotion and disease prevention activities. Ultimately, the balance between increased social connectivity and disease transmission versus health promotion and prevention activities will dictate the effect the Internet has on public health.’’ He added: ‘‘In locales where Internet use is common, those who are engaged in improving public health should assess Internet use and collaborate with local Internet Service Providers to promote health and prevent disease.’’

Barry Whyte, Bulletin

World Health Organization Genebra - Genebra - Switzerland