The Bay Area Reporter - September 3, 1999
Liz Highleyman

The initial July 29 DPH warning, reported in the August 5 issue of the Bay Area Reporter, concerned four cases of early syphilis identified over the previous four weeks, plus a fifth case reported in January. Since that time, four more cases have been identified. Seven of the men are from San Francisco, one is from Marin, and one is from Contra Costa. According to the DPH, eight men met their partners through the America Online (AOL) SFM4M chat room, and one used Internet Relay Chat (IRC). All are white gay men who reported unprotected anal and oral sex. The DPH placed a full-page warning ad in the B.A.R. the following week, and Health Director Dr. Mitch Katz notified the San Francisco Health Commission of the cluster at the board's August 17 meeting.

Syphilis is a sexually transmitted disease (STD) characterized by genital, anal, or oral sores, followed by a rash; some people have no symptoms. The disease, which can be detected using a blood test, is treatable with penicillin, but can lead to heart damage, dementia, and death if left untreated. Recent research indicates that syphilis lesions can increase a person's susceptibility to HIV infection, and the presence of syphilis may also lead to increased HIV viral load. According to a study by Dr. Harrell Chesson and colleagues that appeared in the July 30 issue of AIDS, approximately 1,000 new heterosexually transmitted cases of HIV infection were attributable to syphilis in 1996. Five of the seven recently diagnosed San Francisco men were HIV positive.

Epidemiological reports indicate that syphilis rates are at an all-time low nationally; according to a recent study entitled "The Social and Health Landscape of Urban and Suburban America," syphilis rates in the 25 largest U.S. cities decreased 75 percent from 1990 to 1996. Cases have also declined in San Francisco. There were 30 percent fewer reported cases of early syphilis in the city in the first six months of this year (17 cases) compared to the first half of 1998 (25 cases); the number of later-stage syphilis cases was 62 in the first six months of this year and 64 in the first half of 1998.

Dr. Jeffrey Klausner, DPH director of STD control, called the chat rooms "a new venue where men who have sex with men have an opportunity to meet a wider population of potential sex partners." Klausner told the B.A.R. that chat rooms are not unique, but are "like sex clubs, parks, rest stops, and bars" in providing an opportunity for men to meet many new sexual contacts in a short period of time. Klausner said that "different venues [associated with STD transmission] pop up every few years." IRC and other online discussion forums have existed for more than a decade, but have grown greatly in popularity over the past few years.

Cyberspace has presented new challenges for public health officials due to the anonymity afforded by online communication. Many of the men affected by the recent spate of syphilis cases knew each other only by their "handles," or screen names. Katz noted that this anonymity has made it "extremely difficult and challenging" to locate and notify men who had potentially been exposed. Unlike HIV infection and AIDS, which health officials are prohibited by law from disclosing, partner tracing and notification is standard procedure for syphilis, gonorrhea, and other STDs.

DPH officials approached AOL, which declined to break its policy against disclosing the actual names of members "unless required to do so by law or legal process," or in extraordinary cases of impending danger. In 1997, AOL was criticized for failing to adhere to its own policy when it revealed to investigating military authorities the identity of Chief Petty Officer Timothy McVeigh, who used the word "gay" in his member profile. McVeigh was ousted from the Navy, reinstated under the orders of a U.S. district judge in January 1998, and later resigned.

AOL put the DPH in contact with PlanetOut, a large queer online community affiliated with the Internet service. PlanetOut staff and volunteers participated in the SFM4M chat room and sent users electronic mail and instant messages warning them about the cluster of cases and urging them to practice safe sex and get tested for syphilis. Klausner told the B.A.R. that 99 men had been identified as contacts by the nine infected men, including one man who named 47 partners. Klausner said syphilis testing rates in the city had doubled, and that a third of the identified contacts had been tested.

Media from coast to coast picked up syphilis story, including technology news sources that rarely report on gay sex issues; many could not resist sensationalizing the cyberspace angle. In recent years the media has associated the Internet with pornography and pedophilia, treating the Net as a new and unique phenomenon rather than the latest in a long line of places to meet for sex. Internet chat rooms have also recently played a prominent role in media coverage of barebacking among gay men. As media reports proliferated, an increased number of anti-gay messages began to appear in the SFM4M chat room, which Klausner had identified by name. Users claimed that some of the messages contained profanity and death threats.

Some local activists have criticized the DPH for publicizing the syphilis outbreak in the mainstream media and failing to hold public meetings to inform the gay community directly about the recent cluster of cases. Some have also asserted that the DPH is blowing recent events out of proportion. According to Michael Petrelis, the DPH -- which he has labeled the Department of Public Hysteria -- unjustifiably focuses on the sexual behavior of gay men even though STD rates among heterosexuals are considerably higher. Petrelis called for the DPH to provide proof of the recently reported cases and their connection with the Internet, and called for a series of monthly public forums between the STD control branch and the gay community.

Dave Pasquarelli of ACT UP/San Francisco told the B.A.R. that the group was "outraged that Jeffrey Klausner has called in the Center for Disease Control and Prevention's Epidemic Intelligence Service to slam gay sex and scare up more STD test subjects." The group placed a critical full-page ad in the August 19 B.A.R. asserting that the "syphilis scare is an anti-gay lie," and characterizing the actions of the DPH as part of "a relentless crusade to demonize gay male sex as diseased and deadly."
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