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Characteristics of MSM Syphilis Cases using the Internet to Seek Male Sex Partners, California,

Characteristics of MSM Syphilis Cases using the Internet to Seek Male Sex Partners, California, 2001 - 2003 Terrence Q. Lo 1 , MPH Michael C. Samuel 1 DrPH, Charlotte Kent 2 , Jeff Klausner 2 , Peter Kerndt 3 , Stewart Coulter 1 , Greg Mehlhaff 1 , Dan Wohlfeiler 1 , Gail Bolan 1

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Characteristics of MSM Syphilis Cases using the Internet to Seek Male Sex Partners, California,

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  1. Characteristics of MSM Syphilis Cases using the Internet to Seek Male Sex Partners, California, 2001 - 2003 Terrence Q. Lo1, MPH Michael C. Samuel1 DrPH, Charlotte Kent2, Jeff Klausner2, Peter Kerndt3, Stewart Coulter1, Greg Mehlhaff1, Dan Wohlfeiler1, Gail Bolan1 1California Department of Health Services, STD Control Branch 2San Francisco Department of Public Health, STD Prevention and Control Services 3Los Angeles County Public Health Department, STD Program National STD Conference Philadelphia, PA March 11, 2004

  2. Background • Syphilis is epidemic among gay and other men who have sex with men (MSM) in California • 85% of primary and secondary syphilis cases were among MSM (California, 2001 – 2003) • Traditional syphilis control measures focus on notification, testing, and treatment of locatable sex partners

  3. Primary & Secondary Syphilis Cases by Gender, California, 1996 - 2003 ALL MALE MSM FEMALE 3/04 Provisional Data - CA DHS STD Control Branch

  4. Methods • Operational • Disease intervention specialists (DIS) interview infectious syphilis cases for patient/partner management and surveillance purposes • DIS attempt to contact sex partners • “Non-locatable” sex partners include: • “anonymous” partners • partners known but not disclosed to health department staff

  5. Venue information • “Venues” for meeting partners include: • The Internet is a virtual venue; includes chat rooms, online personal ads, and sex parties posted online

  6. Results • 76% of P&S MSM cases reported any venues from 2001 – 2003 • Top 4 • -Bars/clubs (31%) • INTERNET(28%) • Bathhouses (20%) • Sex clubs (9%) • 67% of P&S MSM cases reported at least one of the Top 4 • 1.3% (5 / 375) heterosexual syphilis cases reported the Internet 3/04 Provisional Data - CA DHS STD Control Branch

  7. % of MSM Syphilis Cases Reporting Meeting Partners by Venue INTERNET Bars/Clubs Bathhouses Sex clubs Trend test for INTERNET, p < 0.0001 Bathhouses and sex clubs combined, p = .04 3/04 Provisional Data - CA DHS STD Control Branch

  8. % of Cases Reporting Internet Only, Commercial Sex Venues (CSV*) Only, Internet and CSV, or Internet and Bars/Clubs INTERNET only CSV* only Internet and CSV* Internet and Bars/Clubs • Trend test for: • Internet only, p < 0.0001 • CSV only, p = 0.002 • Internet and CSV, p = 0.01 • Internet and Bars/Clubs, p=0.10 *Includes bathhouses and sex clubs 3/04 Provisional Data - CA DHS STD Control Branch

  9. % of MSM Syphilis Cases Reporting Meeting Partners through the INTERNET by HIV Status Positive Negative Trend test for HIV+ (p < 0.0001) and HIV- (p < 0.001) significant 3/04 Provisional Data - CA DHS STD Control Branch

  10. % of MSM Syphilis Cases Reporting the INTERNETby Race and Age Group, 2001 – 2003 White Asian Latino Black • Trend test for: • Whites, p = 0.05 • Asians, p = 0.005 • Latinos, p = 0.38 • Blacks, p = 0.29 3/04 Provisional Data - CA DHS STD Control Branch

  11. Characteristics of MSM Cases Reporting the INTERNET vs. those that did not, 2001 – 2003 Among cases that… p < 0.0001 for all 3/04 Provisional Data - CA DHS STD Control Branch

  12. Mean Number and “Non-locatable” Sex Partners by Venue, MSM Primary1 Syphilis Cases 1 Interview period = 3 months *Includes bathhouses and sex clubs 3/04 Provisional Data - CA DHS STD Control Branch

  13. % of Sex Partners that were “Non-locatable” by Venue, MSM Primary1 Syphilis Cases 1 Interview period = 3 months *Includes bathhouses and sex clubs 3/04 Provisional Data - CA DHS STD Control Branch

  14. Conclusions • Among California MSM P&S syphilis cases: • The Internet has become a commonly reported venue • Cases using only the Internet have substantially increased • >80% of partners among cases reporting the Internet were “non-locatable” to health department • Because a significant number of partners are “non- locatable”, traditional syphilis control measures alone are not an effective control strategy

  15. Future research: • HIV sero-sorting and the Internet • Percentage of MSM without syphilis utilizing the Internet • Characteristics of MSM using the INTERNET only • Proportion of “non-locatable” partners truly anonymous versus those who could be located through other strategies Recommendation • Comprehensive syphilis control strategies should incorporate appropriate Internet-based interventions

  16. Terrence Q. Lo Epidemiologist CA Department of Health Services STD Control Branch (510) 883-6653 tlo@dhs.ca.gov

  17. Number of MSM P&S Syphilis Cases by Region and Year 2/04 Provisional Data - CA DHS STD Control Branch

  18. % of MSM Syphilis Cases Reporting Meeting Partners through the INTERNET by Region San Francisco Rest of California Los Angeles 3/2004 Provisional Data - CA DHS STD Control Branch

  19. % of MSM Syphilis Cases Reporting Meeting Partners by Venue INTERNET Bars/Clubs Bathhouses Sex clubs Trend test for INTERNET, p < 0.0001 1/2004 Provisional Data - CA DHS STD Control Branch

  20. % of Cases Reporting Only Internet, Only Commercial Sex Venues (CSV*), Internet and CSV, or Internet and Bars/Clubs INTERNET only CSV* only Internet and CSV* Internet and Bars/Clubs • Trend test for: • Internet only, p < 0.0001 • CSV only, p = 0.001 • Internet and CSV, p = 0.02 • Internet and Bars/Clubs, p = 0.11 *Includes bathhouses and sex clubs 1/2004 Provisional Data - CA DHS STD Control Branch

  21. % of MSM Syphilis Cases Reporting Meeting Partners through the INTERNET by Region San Francisco Rest of California Los Angeles 1/2004 Provisional Data - CA DHS STD Control Branch

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