From: MPetrelis@aol.com Date: Thu, 27 Jul 2000 12:40:27 EDT Subject: JAMA: SF syphilis rate at "lowest number ever reported," 40 in 98, 41 in 99 Pull quotes: "Case subjects were early-stage syphilis cases among gay men reported to SFDPH in July and August 1999 and were not necessarily part of the outbreak cluster." "Following news reports of the syphilis cyberspace outbreak,(7, 8) the SFM4M chat room was deluged by online antigay hate messages.(9)" "In San Francisco, there were only 40 cases of early-stage syphilis reported in 1998 the lowest number ever reported and 41 cases in 1999." * * * Web link: Click here: Tracing a Syphilis Outbreak Through Cyberspace http://jama.ama-assn.org/issues/v284n4/full/joc00896.html JAMA. 2000;284:447-449 Journal of American Medical Association July 26, 2000 Tracing a Syphilis Outbreak Through Cyberspace by Jeffrey D. Klausner, MD, MPH; Wendy Wolf, MPA; Lyn Fischer-Ponce, MPA; Ilene Zolt, BA; Mitchell H. Katz, MD Context: A recent outbreak of syphilis among users of an Internet chat room challenged traditional methods of partner notification and community education because locating information on sexual partners was limited to screen names and privacy concerns precluded identifying sexual partners through the Internet service provider. Objectives: To determine the association of Internet use and acquisition of syphilis and to describe innovative methods of partner notification in cyberspace. Design, Setting, and Patients: Outbreak investigation conducted at the San Francisco (Calif) Department of Public Health (SFDPH) in June-August 1999 of 7 cases of early syphilis among gay men linked to an online chat room; case-control study of 6 gay men with syphilis reported to SFDPH in July-August 1999 (cases) and 32 gay men without syphilis who presented to a city clinic in April-July 1999 (controls). Main Outcome Measures: Association of syphilis infection with Internet use, Internet use among cases vs controls, and partner notification methods and partner evaluation indexes. Results: During the outbreak, cases were significantly more likely than controls to have met their sexual partners through use of the Internet (67% vs 19%; odds ratio, 8.7; P = .03). We notified and confirmed testing for 42% of named partners; the mean number of sexual partners medically evaluated per index case was 5.9. Conclusions: In this study, meeting sexual partners through the Internet was associated with acquisition of syphilis among gay men. Public health efforts must continually adapt disease control procedures to new venues, carefully weighing the rights to privacy vs the need to protect public health. JAMA. 2000;284:447-449 [Deleted article. filemanager@qrd.org] To eliminate syphilis it is crucial for public health departments to respond rapidly in innovative ways to clusters of disease and newly identified social-sexual networks. This outbreak indicates that the Internet is a technology that may facilitate transmission of syphilis but may also provide targeted awareness and enhance control of STDs. Author/Article Information -- Author Affiliations: San Francisco Department of Public Health (Drs Klausner and Katz and Mss Wolf, Fischer-Ponce, and Zolt) and Department of Medicine, Division of AIDS and Oncology, University of California, San Francisco (Drs Klausner and Katz); and the National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga (Ms Wolf). Corresponding Author and Reprints: Jeffrey D. Klausner, MD, MPH, STD Services, 1360 Mission St, Suite 401, San Francisco, CA 94103 (e-mail: jeff_klausner@dph.sf.ca.us). Acknowledgment: We thank the San Francisco Department of Public Health Syphilis Elimination Team: Veronica Davila, John Tambis, Rosito Bartolini, Tony Tran, Joseph Engelman, MD, and Robert Kohn, MPH, for their innovative and tireless efforts during this investigation; and Charlotte Kent, MPH, for her helpful comments in the preparation of the manuscript. REFERENCES 1. Cates W, Rothenberg RB, Blount JH. The historic context and epidemiologic basis for interrupting sexual transmission of Treponema pallidum. Sex Transm Dis. 1996;23:68-75. MEDLINE 2. Moore MB Jr, Price EV, Knox JM, Elgin LW. Epidemiologic treatment of contacts to infectious syphilis. Public Health Rep. 1963;78:966-970. 3. Dougherty WJ. Epidemiologic treatment of syphilis contacts. J Med Soc NJ. 1962;59:564-567. 4. Rothenberg RB, Potterat JJ. Strategies for management of sex partners. In: Holmes KK, Mardh PA, Sparling PF, et al, eds. Sexually Transmitted Diseases. New York, NY: McGraw-Hill Co; 1984:970. 5. 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Gay men report high rates of unprotected anal sex with partners of unknown or discordant HIV status. AIDS. 1999;13:1525-1533. MEDLINE ==================== Michael Petrelis Welcome to AIDS-STATISTICS www.AIDS-statistics.com 2215-R Market Street, #413 San Francisco, CA 94114