1. 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 1 California Department of Health Services, STD Control Branch 2 San Francisco Department of Public Health, STD Prevention and Control Services 3 Los Angeles County Public Health Department, STD Program National STD Conference Philadelphia, PA March 11, 2004

2. 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 Background

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

4. 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 Methods

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 INTERNET Sex clubs Bathhouses Bars/clubs Motels Parks Streets Other venues (resorts, circuit parties, private parties, adult bookstores/theaters, telephone chat lines, gyms)

10. Results 3/04 Provisional Data - CA DHS STD Control Branch 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

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

12. % of Cases Reporting Internet Only, Commercial Sex Venues (CSV*) Only, Internet and CSV, or Internet and Bars/Clubs INTERNET only CSV* only Internet and Bars/Clubs Internet and CSV* 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 3/04 Provisional Data - CA DHS STD Control Branch *Includes bathhouses and sex clubs

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

14. % of MSM Syphilis Cases Reporting the INTERNET by Race and Age Group, 2001 – 2003 White 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 Asian

15. Reported Internet Did not report Internet Male and female partners 3%8% Methamphetamine use28% 15% Anonymous sex partners72% 59% College graduate or advanced degree47%35% p < 0.0001 for all Characteristics of MSM Cases Reporting the INTERNET vs. those that did not, 2001 – 2003 Among cases that… 3/04 Provisional Data - CA DHS STD Control Branch

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

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

21. 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

22. Future research: 1.HIV sero-sorting and the Internet 2.Percentage of MSM without syphilis utilizing the Internet 3.Characteristics of MSM using the INTERNET only 4.Proportion of non-locatable partners truly anonymous versus those who could be located through other strategies Comprehensive syphilis control strategies should incorporate appropriate Internet-based interventions Recommendation

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

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

26. % 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

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

28. % of Cases Reporting Only Internet, Only Commercial Sex Venues (CSV*), Internet and CSV, or Internet and Bars/Clubs INTERNET only CSV* only Internet and Bars/Clubs Internet and CSV* *Includes bathhouses and sex 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 1/2004 Provisional Data - CA DHS STD Control Branch

29. % 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