Syphilis, a disease most people associate with the past, has returned with a roar, and public health experts think the rise in rates can be attributed at least partly to social media.
Infection rates are the highest they have been in 20 years, said David Harvey, the executive director of the National Coalition of STD Directors. From 2014 to 2015 alone, the number of syphilis cases reported to the Centers for Disease Control and Prevention (CDC) rose by 17.7%, from 63,453 to 74,702.
Along with cuts in STD prevention and treatment resources and possibly more relaxed attitudes toward protection since the advent of life-saving HIV treatments, health experts think the influence of social media on how people meet sex partners may play a role in the upswing.
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“The way our society is forming partners is now through using a lot of social media, and that is affecting the sexual transmission dynamics we are seeing,” said Gail Bolan, the director of the Division of STD Prevention at the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.
Tracking and controlling transmission are already tricky since the disease manifests as a small painless lesion about a month after exposure. Nicknamed the “The Great Pretender,” it can cause a head-scratching constellation of symptoms or none at all, depending on the stage.
Technology has complicated matters even further, said Katherine Hsu, the medical director of the Massachusetts Department of Public Health’s Division of STD Prevention & HIV/AIDS Surveillance.
When a person tests positive for syphilis in Massachusetts, the case is reported to the state public health department, which reports it to the CDC without identifying the person. Trained workers from Hsu’s division interview the person about any partners who may have been exposed. They then track down and notify those partners — discreetly, Hsu added, in a way that keeps the source of information anonymous.
Hsu said this “on-the-ground” approach has encountered significant challenges in today’s world of dating apps. Before, when “an individual had (primary stage syphilis) and they knew the ... people they were within the past 90 days, they could find the people.”
Now, she said, “it’s very difficult to contact the partners, because many partners are anonymous.” People don't know their sex partners as intimately as they once did; they may be individuals they know mostly through a profile photo and short blurb. Depending on the app, people may only identify themselves by first names or handles, though they often have the option of linking with their Facebook accounts.
Hsu has also found that people sometimes delete their profiles before her division can find them to tell them they may have been exposed to an STD.
“We just can’t keep up,” she said.
Dating apps doing more
Tinder, an app that has people swipe left or right depending on whether they “like” someone or not, processes 26 million matches every day and 1.5 million dates every week, according to its website. It has a “Safety Tips” section under the app’s “Settings" that discusses protection measures such as using a condom, and features a link to a CDC website with information on getting tested. The company did not respond to a request for comment.
It is important for dating apps to promote STD awareness and prevention, says Philip Chan, the director of the HIV/STD Testing and Prevention Services at the Miriam Hospital Immunology Center in Rhode Island. Gay dating apps in particular are starting to do more of this, he said.
“The majority of (syphilis) cases are among gay, bisexual and other men who have sex with men,” Chan said. According to the CDC, men who have sex with men accounted for 14,229 out of 23,872 (59.6%) cases of primary and secondary syphilis — the most infectious stages of the disease — in 2015.
Grindr, a gay dating app with 3 million daily active users, has a "Sexual Health” section on each user’s profile where the user can list HIV status and the last time they were tested. That same section also features a link to a “Sexual Health FAQ” page where the user can learn more about HIV, getting tested and related topics.
Grindr for Equality, the app’s health and social justice arm, partners with a network of LGBTQ community centers called CenterLink to offer free ad space to small, rural community centers that offer health services in places where there may be few alternatives, according to Director of Grindr for Equality Jack Harrison-Quintana.
Grindr is also active in Building Healthy Online Communities (BHOC), a group of public health leaders, researchers and gay dating apps that work to support HIV and STD prevention online, he said.
And Manhunt, which calls itself “the world’s biggest gay hookup site,” partners with Manhunt Cares, an organization that provides health resources for Manhunt's 237,000 active users and the LGBTQ community at large.
It also works with public health departments when it comes to notifying a partner who may have been exposed to an STD, according to Senior Health Strategist David Novak, who served as the national syphilis elimination coordinator at both the CDC and the Massachusetts Department of Public Health before coming to work at Online Buddies, Manhunt’s parent company.
“Partner notification was historically performed on a face-to-face basis, but with populations moving to dating sites/apps, a new strategy for delivering disease outbreak interventions was necessary,” said Novak, who worked with Hsu during his time at the Massachusetts Department of Public Health.
Public health professionals trained by the CDC will set up partner notification profiles on Manhunt. These profiles, which have a special logo, only contact users if they may have been exposed to an STD.
“Contact investigation has evolved where we use newer tools,” Hsu said. “We will go on (social media), use public information and find ways to track people using their handles.”
Budget cuts a factor
Such partnerships are important, both Hsu and Chan of Rhode Island say. However, they must be built upon strong state and local screening, prevention and treatment efforts.
In 2012, more than half of all state and local STD programs experienced budget cuts, which resulted in reductions in clinic hours, contact tracing and screening for common STDs, according to a 2016 CDC report. Twenty-one clinics closed that year, the report said.
“We have seen the significant impact of state and local budget cuts in STD prevention programs,” the CDC's Bolan said.
On top of that, “tremendous cuts are being projected by the current administration,” Hsu said. The White House’s 2018 budget proposed a $186.1 million reduction in funding for HIV/AIDS, viral hepatitis, STD and tuberculosis prevention.
Bolan said she is particularly concerned about syphilis: It was almost eliminated a decade ago, she said, but “now it is rising with all populations — men, women and newborns, and we are seeing these increases in every region of the country.”
“We need to improve our screening and treatment,” she said. “And we need our communities to realize syphilis is back. They think it’s an ancient disease, but people need to realize this is a significant health problem.”
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