Chicago Tribune - July 14, 2008
Deborah L. Shelton, dshelton@tribune.com

The trend is significant because health experts believe Internet hookups are helping to fuel a syphilis epidemic among men with same-sex partners.

The report was based on confidential interviews conducted as part of the health department's routine disease-surveillance activities. It was the first time more men said they met sex partners online than in places such as bars, said Dr. William Wong, medical director of the health department's division of sexually transmitted disease, HIV and AIDS.

The Internet is not the cause of the upsurge in infectious syphilis cases among men who have sex with men, but it increases the chances of disease transmission, said Deborah Levine, executive director of the Oakland, Calif.-based Internet Sexuality Information Services, a non-profit group that develops Internet technologies to prevent the spread of sexually transmitted diseases.

"If you go to a bar in a night, there might be 200 or 300 people there," Levine said. "You can go on multiple Web sites in a night and potentially meet thousands of people. The speed and sheer numbers allow for more possibilities for passing around infections."

In 1999, the Centers for Disease Control and Prevention launched a national plan to eliminate infectious syphilis from the United States. But even as rates among heterosexuals have dropped dramatically, sinking to a historic low, rates among men who have sex with men have soared.

The shift has set back local and national health campaigns aimed at preventing new cases of the disease.

The number of syphilis cases in Chicago hovered around 300 annually for about a decade. Until 2001, most of the cases were among heterosexual men and women.

Then the trend shifted. Last year 331 syphilis cases were reported in Chicagoù71 percent of them among men with same-sex partners.

Nationally, about 36,000 cases were reported in 2006.

Syphilis is easily treated with penicillin in its early stages. Untreated, it can damage internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones and joints.

According to the health department survey, 34 percent of men diagnosed with syphilis last year at city health department STD clinics said they met their sex partners on the Internet, Wong said. That compared with 33 percent of men who said they met their sex partners at bars or clubs.

"Prevention does work, and the reductions over the last 10 years among women and the heterosexual community are an important advance," Wong said. "We are making progress. But syphilis is still around and there's still work to be done."

One concern is the increasing number of people diagnosed with syphilis who also are HIV-infected. Among heterosexuals diagnosed with syphilis at city clinics four years ago, 6 percent were infected with HIV. Last year it was 15 percent.

The majority of men diagnosed with syphilis at Howard Brown Health Center already are HIV-infected or finding out about their HIV infection at the same time of their diagnosis, said Daniel Pohl, the health center's manager of disease-intervention services.

Unprotected oral sex is mistakenly considered safe, but it can be risky in the case of syphilis if there are sores on the genitals or in the mouth, Pohl said.

"They think casual oral sex won't have repercussions," he said. "But with syphilis, it can."

Though the Internet has created new challenges, it also offers opportunities for intervention, Wong said.

The National Coalition of STD Directors published national guidelines on Internet-based interventions to help health departments use the Web in outreach activities.

The Chicago health department has tried different strategiesùfrom beefing up its Web site with information about syphilis, to posting banner ads on other Web sites and launching a Web site called inSPOT, which is run in partnership with Internet Sexuality Information Services.

The site combines the concept of an electronic greeting card with information about STDs.

Men can send an anonymous, confidential e-mail notifying their partners that they have been exposed to a sexually transmitted disease.

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