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"This has been an innovative and effective way for us to enable people to communicate with their sex partners," said Dr Jeffrey Klausner, director of STD prevention and control services at the San Francisco Department of Health.
The inSPOT service, which was created in San Francisco in 2004, is now in place in several states, including Idaho, Louisiana, New York, Oregon, Pennsylvania and Washington, among others. According to the report, the service "has the potential to be a national and international resource."
"We know inSPOT works," Klausner said. "I see patients, they come in and say they've been notified [about having an STD], and their contact is through inSPOT."
Service initially developed for gay men
Typically, health departments in the United States only notify the sexual partners of people with STDs if they might be infected with syphilis, Klausner said. Officials don't try to track down the partners of people with HIV, the virus that causes Aids, or diseases such as gonorrhoea and Chlamydia, he said.
The San Francisco Department of Public Health and a non-profit group surveyed gay men in 2004 and found that most didn't notify casual sex partners when they were diagnosed with an STD. But the report said men "overwhelmingly said that if there were an easy, convenient and anonymous way to inform their partners of their potential disease exposure, they would use it."
And so the inSPOT service was born, first as a service for gay men and then for anyone. Users visit a web site and click through a form that allows them to submit the e-mail address of a sex partner and specify what disease or diseases the person may have been exposed to. The person potentially exposed to an STD will then get an e-mail with the subject line, "E-card from a concerned friend re: your health via inSPOT."
People who send the messages can choose to be anonymous or include their name. They also get to choose images to appear on the e-cards, including a photo of the words "I'm so sorry" on a piece of paper.
"We're living in a new world of internet communication," Klausner said. "Most people are online every day. This internet communication tool affords people a way to send a message anonymously."
15% of messages warned of gonorrhoea infection
According to the new report, published in the October issue of PLoS Medicine, 15% of the e-cards in 2006 and 2007 warned recipients of gonorrhoea infection. The percentages for other diseases were 15% for syphilis, 9% for HIV and 12% for Chlamydia. Almost half of the cards warned of other diseases, including "crabs" (pubic lice) and hepatitis.
Since 2004, 30 000 people have sent nearly 50 000 e-cards, the report said. It is possible for people to abuse the message service to harass or frighten others; there's no way to confirm that those who receive messages are actually in danger of infection. Still, there's little indication that people have abused the system, at least in San Francisco, Klausner said.
"I've probably gotten four e-mails from people who have been upset because they think they shouldn't have gotten this card, someone misused it," Klausner said. "They couldn't believe something this serious could so easily have the potential for misuse."
It's not clear if the notification service actually helps reduce sexually transmitted disease. "The real test of this or any approach, including the traditional ones, is their effect on transmission," said Dr Richard Rothenberg, a professor at Georgia State University's Institute of Public Health, who studies partner notification.
However, it may be difficult, if not impossible, to study the impact on health because the service is confidential, Rothenberg said. "I think we, and the authors, must be content with the idea that this appears to be an acceptable method to fulfil the moral imperative of notification, and it has a chance to be a better approach than what we currently do," he said. – (HealthDay News, October 2008)
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