1. Finding Sex Partners On-Line: What’s the Risk for STI
Finding Sex Partners On-Line: What’s the Risk for STI? Might There be a Benefit?
Alia Al-Tayyib, PhD and Cornelis Rietmeijer, MD, PhD
Denver Public Health Department
Denver, CO

2. Why all the hype?
The Internet has provided a new environment for seeking and meeting sexual partners
Soliciting sexual partners on-line is becoming more prevalent, particularly in some groups
This behavior has been implicated in increased risk for STI and HIV infection

7. Current State of Knowledge
Previous studies have evaluated Internet sex partners as an outcome
Comparisons made between persons seeking sex on the Internet to persons who were not seeking sex on the Internet
Focus has been on men who have sex with men (MSM)

8. What’s the issue?
Unclear from existing literature whether seeking sexual partners on the Internet is simply a marker of high risk sexual behavior or whether it actually increases one’s risk taking behaviors resulting in STI/HIV infection

9. Objective
To assess the association between reporting sex with Internet partners and current infection with Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (GC)

10. Methods
Electronic medical record review of patients attending the Denver Metro Health Clinic
August 2006 to September 2007
Retrospective case-control study
Analysis limited to patients who were tested for Ct or GC during their clinic visit
New diagnosed HIV infection and early syphilis were also considered

11. Main Measures
Case: any patient testing positive for Ct or GC between August 2006 and September 2007
Control: any patient testing negative for Ct or GC during same period
Main exposure: self-reported sexual encounters with partners met via the Internet
Ever vs. Never
Restricted to Ever: past 4 months vs. > 4 months

12. Other Measures Demographics Sexual behaviors History of STI Race Age
Condom use with non-main partner
Number of partners past 3 months
History of STI
History of Ct
History of GC
Current HIV status

13. Analysis
A-priori decision made to examine data separately by sexual orientation
Multivariable modeling using generalized linear models with log link and binomial error distribution
Unadjusted odds ratios and 95% CI
Adjusted odds ratios and 95% CI
A backwards elimination, change-in-estimate strategy was used to assess confounding

14. Study Flow

15. Sex with Internet Partners
MSM
N (%)
MSW
Women
< 4 months
465 (25.2)
173 (2.7)
76 (1.6)
4 – 12 months
158 (8.5)
64 (1.0)
26 (0.6)
> 12 months
186 (10.1)
119 (1.8)
52 (1.1)
Never
1038 (56.2)
6097 (94.5)
4549 (96.7)

16. Demographics

17. Sexual Behaviors

18. STI History and HIV Status

19. Association Between Internet Partner and Current Ct/GC Infection
MSM (N=1838)
OR (95% CI)
MSW (N=6180)
Women (N=4538)
Unadjusted
Internet partner
Ever
Never
0.92 (0.70, 1.20)
1.0 (ref)
0.59 (0.42, 0.81)
0.57 (0.32, 1.01)
Adjusted
> <
0.74 (0.53, 1.03)*
0.66 (0.37, 1.18)*
NOTES: *adjusted for race

20. Association Between Internet Partner and Current Ct/GC Infection
MSM (N=809)
OR (95% CI)
MSW (N=356)
Women (N=154)
Unadjusted
Internet partner
Past 4 months
> 4 months
1.21 (0.80, 1.85)
1.0 (ref)
0.53 (0.27, 1.02)
1.96 (0.63, 6.15)
Adjusted
0.93 (0.60,1.46)*
> <
1.89 (0.57,6.32)**
NOTES: *adjusted for number of partners last 3 months
**adjusted for number of partners last 3 months and race

21. Limitations
Cross-sectional chart review of a clinic-based convenience sample
All behavioral assessments conducted in the context of routine clinical interview
Single question asking whether a person had sex with a person first met on the Internet
Do not know the specifics of the Internet sites

24. Conclusions
Sexual encounters with partners met on the Internet may not be as risky as previously thought
May actually be protective in some groups

25. Acknowledgements Internet and STD Center of Excellence
Mary MacFarlane
Rachel Kachur
Clinical staff at DMHC

26. Thank You