Today seemed like a good day for a repost. This piece gets lots of hits, albeit probably not what the searcher was hoping for. --PalMD
To people who grew up before the internet, the debate about whether Craigslist should be allowed to post “erotic services” must seem bizarre. But meeting people online, whether for romance, friendship, collegiality, or anonymous sex is becoming not only common, but has lost its novelty. This isn’t going anywhere. The most compelling argument I’ve heard for asking Craigslist to abandon its lucrative paid sex ads is that it helps perpetuate an oppressive and violent sex trade, one that essentially enslaves women and turns them into chattel for the profit of others. That’s pretty damned compelling.
But should those of us who care about public health focus only on the "sex work” section of online bulletin boards? People meeting not only for romance but also for consensual, sometimes anonymous sex has become increasingly common. Like the bath houses of the 1970s, could online sex encounters possibly encourage the risk of sexually transmitted infections?
Data from before the late 1990s are hard to find, since broadband internet services were not widely available. In 2000, a study of a small syphilis outbreak among men who have sex with men (MSM) found that the men who had syphilis were much more likely to have met partners in an online chat room than men without syphilis. This made notification of contacts (for control of the outbreak) more difficult. Of note, when public health authorities launched an informational campaign about the phenomenon, gay online chat rooms were flooded with anti-gay hate messages, perhaps interfering with effective outreach.
Since that initial report, further studies seemed to confirm that meeting sex partners online conferred an increased risk for sexually transmitted diseases, especially among men who have sex with men. A more recent study from the journal Sexually Transmitted Infections aimed to clarify this risk.
The authors combed the records of a sexual health clinic in Denver for patients with a history of chlamydia or gonorrhea confirmed by laboratory testing. They then looked for a history of having sex with someone met online (this was a question asked of all the patients). Neither the group with these infections nor those without were more likely to have met sex partners online, arguing against what has become common knowledge. Earlier data suggested any effect might be more prominent among MSM, but while they found MSM to be significantly more likely to find sex partners online, there was no significant difference in infection rates between MSM and other groups.
The authors discuss possible weaknesses of this study, but there a few critical problems left undiscussed. Chlamydia and gonorrhea are not terribly rare in men who have sex with men, but left out were syphilis, HIV, and HPV infections. These infections have been implicated in earlier reports of online sexual behavior. While it is encouraging that sexual encounters that originate online may not be a unique risk factor for gonorrhea and chlamydia, these other diseases can be pretty devastating.
If the internet may increase the risk of STIs, it may also give us unique opportunities to reach out to people at risk. There are services that allow you to anonymously email a sexual partner to inform them of “bad news”. Internet sites that are used for finding sexual partners sometimes have links to websites with sexual health information (although how effective this might be at mitigating risky behavior is a big unknown).
Ten years ago, not many Americans had internet access, and even fewer had broadband access. Human ingenuity inserted sex into online interactions early, and increasing penetrance of the internet into our lives may increase the frequency of risky sexual encounters. In And the Band Played On, journalist Randy Shilts reported the difficult work of teasing out the origins of the AIDS pandemic, including the sociopolitical challenges of telling a despised minority that some of their behaviors were risky. Studies like the one one on chlamydia and gonorrhea will hopefully help flesh out the interaction between internet hook-ups and health risks so that we can better target at risk groups for preventative education.
Klausner JD, Wolf W, Fischer-Ponce L, Zolt I, & Katz MH (2000). Tracing a syphilis outbreak through cyberspace. JAMA : the journal of the American Medical Association, 284 (4), 447-9 PMID: 10904507
Mary McFarlane, PhD; Sheana S. Bull, PhD, MPH; Cornelis A. Rietmeijer, MD, MPH (2000). The Internet as a Newly Emerging Risk Environment for Sexually Transmitted Diseases JAMA, 244 (4), 443-446 DOI: 10.1001/jama.284.4.443
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McFarlane M, Bull SS, & Rietmeijer CA (2002). Young adults on the Internet: risk behaviors for sexually transmitted diseases and HIV(1). The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 31 (1), 11-6 PMID: 12090960
Centers for Disease Control and Prevention (CDC) (2003). Internet use and early syphilis infection among men who have sex with men--San Francisco, California, 1999-2003. MMWR. Morbidity and mortality weekly report, 52 (50), 1229-32 PMID: 14681596
A A Al-Tayyib1, M McFarlane, R Kachur, C A Rietmeijer1 (2009). Finding sex partners on the internet: what is the risk for sexually transmitted infections? Sexually Transmitted Infections, 85, 216-220 DOI: 10.1136/sti.2008.032631