When Kevin* feels like having sex, he logs on to the Internet, enters a chat room, and arranges an in-person meeting. Based on a photograph, he knows that the guy will be hot. He also knows what kind of sex he can expect because it's been discussed via email. What he doesn't know is whether or not he is going to catch a sexually transmitted disease (STD).

Kevin is not unlike thousands of other people who look for sex using the Internet. Unfortunately, people who find sex partners online are at greater risk for catching STDs, according to two studies published in the July 26th issue of the Journal of the American Medical Association (JAMA).

More than 850 people were surveyed at the Denver Public Health HIV Counseling and Testing Site in Colorado between September of 1999 and April 2000. Participants answered questions about the Internet as well as risk assessment questions. Most of the clients were white (77.8 percent) and male (69.2 percent). More than half (65.3 percent) were heterosexual.

People who found sex partners online reported more previous STDs, more sex partners, more anal sex, and more sexual exposure to men who have sex with men, and partners known to be HIV positive. In addition, more than half of the people who found sex on the Internet also reported not using a condom during their last sexual encounter.

Internet sex seekers were also more likely to be men and homosexual compared with those not seeking sex via the Internet, according to the results of this study. The anonymity of the Internet might offer a greater appeal for men who have sex with men (MSM), says Mary McFarlane, PhD, from the Centers for Disease Control and Prevention (CDC), and lead author of the study. "There are a lot of people that are questioning their sexuality who don’t want their wives or mother to find out. The Internet is a good place to hide," she says.

 

"People don't necessarily have the inhibitions on the Internet that you might have if you meet someone in a bar or at work." -- Mary McFarlane, PhD

 
Instead of going to a bar or club, thousands of people are meeting online. "People don't necessarily have the inhibitions that you might have if you meet someone in a bar or at work," says Dr. McFarlane. "What can happen on the Internet is that people feel freer to talk about their deepest fantasies," she says. At times, however, this freedom can be dangerous, especially if people arrange beforehand to have sex without a condom, she warns. "Because of that [freedom], when they then meet in person, they are primed to 'go for it'," says Dr. McFarlane. "Going for it" on the Internet can mean a range of things -- from seeking relationships or making dates to arranging sex, at times unprotected sex.

Syphilis Outbreak in M4M Chat Room
When sexual partners of two men who had syphilis were traced back to an Internet chat room, health officials from the San Francisco Department of Public Health found themselves in unfamiliar territory. The two men had met a majority of their sexual partners within the past year through an Internet chat room called SFM4M, and only knew them by their screen names.

Because the Internet Service Provider (ISP) would not release identifying information without a federal subpoena, the health officials had to contact people via the Internet. Hundreds of users were contacted electronically by a marketing firm and they were informed of the syphilis cluster. People were also encouraged to seek medical evaluation if they had sexual contact with someone they met in a chat room. "This is the first time that the Internet was the primary means by which partners were notified," says the lead author of the study, Jeffrey D. Klausner, MD, MPH, of the STD Services at the San Francisco Department of Health. Compared with other cases of offline notification, these efforts were successful, he says.

   
Through case interviews, notifying sexual partners, and raising community awareness, five related cases were identified, including a previous case from January 1999 and four new cases, resulting in a total of seven SFM4M chat room-related cases among gay white men.

Meeting sexual partners through the Internet was associated with risk of syphilis among gay men, according to this study. "Public health efforts must continually adapt disease control procedures to new venues, carefully weighing the rights to privacy versus the need to protect public health," the study concluded.

Taking Prevention Efforts Online
Just as the Internet has opened up doors to risky sex practices, it has also presented new opportunities for medical providers and educators. "In some ways [notifying people via email] may be more efficient because you can deliver the message as well as confirm that someone has received the messages. It offers 24 hour delivery options. We don't have to worry about calling or knocking on a door too early or too late," says Dr. Klausner.

Indeed, time is crucial when it comes to STD prevention. The faster you get tested and treated the better, not only because the STD will become worse, but also because having an STD puts you at greater risks for catching other STDs including HIV, says Dr. McFarlane.

As always, condom use is a must when having sex with people you meet online, she says. "We recommend safer sex, meaning correct and consistent condom use. Knowing your risks and understanding when you are at risk is half the battle. Taking precautions to reduce those risks is the other half. We need to accomplish both halves," she urges.

In addition to offering STD notification opportunities, the Internet may also prove useful for counseling and education efforts. The in-person counseling that is done in clinics can be augmented by online social support, discussion groups or by counselors following up with patients via email, says Dr. McFarlane. "There is also the possibility that we could promote testing and treatment for STDs online," she says.

How to fully integrate the Internet into healthcare is still in developmental stages. "The Internet is a new social phenomenon," says Dr. McFarlane. The CDC and other healthcare organizations want to understand what goes into a sexual encounter that's facilitated in cyberspace, she says. "We want to understand what it is that goes into this phenomenon before we start making recommendations about it or developing interventions," she adds.

But don't be surprised if you are asked questions about finding sex partners online at your next visit to an STD/HIV clinic. "HIV counselors should include a discussion of how partners are solicited. If the counselors find that multiple and anonymous partners are being solicited in any way (including the Internet), it should be considered a risk behavior," says Dr. McFarlane.

*name was changed

Updated: Wednesday, January 23rd 2002