You've Got Mail. And Maybe Something Else.

Tuesday, October 21, 2008

The conversation is as painful as the herpes sore that compels it, but saying it digitally may provide some salve.

An online service ( http://www.inspot.org) that lets you notify partners if you have a sexually transmitted disease, or STD, is starting to tally its results. So far, so good.

Since its 2004 launch, more than 30,000 people have sent e-postcards, the San Francisco-based founders report today in the Public Library of Science Medicine. This year, 1,441 D.C. residents have used the local version of the service to notify 2,192 partners (that's 1 1/2 partners per person) about afflictions ranging from crabs to chlamydia.

In 2001, when a syphilis outbreak among gay and bisexual men in San Francisco was traced back to an AOL chat room, Jeffrey Klausner, director of STD Prevention and Control Services at the San Francisco Department of Public Health, had an idea: If some men were going online to find casual sex, he thought, why not use the same medium to handle the consequences?

Klausner teamed up with the nonprofit Internet Sexuality Information Services and, with community support and feedback, launched the inSPOT service. Initially targeted at men who sleep with men, the project has expanded to include people of both sexes and all sexual orientations, and it has been replicated in two other countries, nine states and nine cities.

The tone of the e-cards ranges from serious to sassy: "It's not what you brought to the party," reads one. "It's what you left with. I left with an STD. You might have, too. Get checked out soon."

The site prompts you to select the STD you've contracted from a scroll-down list and to enter the e-mail addresses of up to six partners from the past six months. You can send the e-card anonymously or from your own address, with a personal message. InSPOT also offers STD information and links to testing sites and resources.

While it's not known how many recipients follow up with testing and treatment, up to a third of e-card recipients click through the resource information, and Klausner said he has seen many of them come through his clinic.

Diagnosis of an STD such as syphilis usually prompts the local health department to find and treat the people spreading the illness, said Charlotte Gaydos, a professor of medicine at Johns Hopkins University. But deploying field workers can be expensive and difficult, especially if the person who has been infected does not have the names and addresses of all recent sex partners.

E-cards provide a cheap option that allows infected people to alert their partners without the awkwardness of doing so in person, said Emily Erbelding, chief of clinical services for the Baltimore City Health Department's STD program. And that is attractive to underfunded health departments. The Centers for Disease Control and Prevention also offer e-cards on "STD awareness," though these are less direct in their message.

Most of her patients want to do the responsible thing, Erbelding said. "[But] some people might never want to see the person again, so an anonymous e-card is just a whole lot easier."

"This is not a cure-all," Klausner said. "[But] you've got to offer people as many choices as you can."

The CDC estimates that 19 million STD cases are diagnosed in the United States every year.

-- Ishani Ganguli


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