Wednesday, March 12, 2008
Syphilis cases in San Francisco increased from 41 in 1998 to 493 in 2002. Most cases were among men who have sex with men: only 11 cases were identified among women in 2002. Feedback from MSM focus groups suggested a change in focus from education on condoms and numbers of partners to getting tested regularly.
Our objective was to evaluate whether a web site could facilitate syphilis testing and identify new cases.
A web site was created (STDtest.org) where patients could print out a lab slip and get tested for syphilis at a private laboratory. Results were reported to the health department and then posted on the web site, where the patients could obtain them using an anonymous nine-digit ID number. STD staff followed up with every newly-reactive client to ensure that new cases received treatment.
STDtest.org launched in May, 2003. Through October, 2007, 801 tests have been conducted among 673 unique patients. Of the 51 reactive serologies, 2 (3.9%) were biological false positives, and 22 more (43.1%) were previously treated cases. One client was unable to be located. Of the 19 new cases identified, 1 was late latent, 5 were early latent, 10 were secondary, and 3 were primary syphilis. These represent only 0.9% of the 1937 early syphilis cases identified in San Francisco over this same period.
This project had the highest proportion of cases among tests (2.3%) of all program screening activities, including the STD clinic (1.4%), a gay men's health center (1.2%), and correctional facilities (0.1%).
This project has been productive in identifying cases in relation to other screening projects, and has done so at very low costs. It has not proven to identify a substantial number of new cases, however.
On-line testing may be a cost-effective means to improve syphilis case detection.