You've Got Mail ... and an STD

Study Shows Using E-postcard to Warn Past Partners Is Catching On

By LAUREN COX
ABC News Medical Unit

Oct. 21, 2008â€”

If a card that reads "you're too hot to be out of action - I got diagnosed with herpes since we played" ends up in your inbox, think twice before marking it spam.

A public health Web site called Inspot.org has put the trend of e-cards, e-mail, and e-vites to a unique purpose: the e-postcard that notifies you that a past sexual partner came down with a sexually transmitted disease or infection.

The sender can choose the STD, and whether to disclose their name, while Inspot.org will automatically send a list of local health resources to the recipient.

"Believe it or not, I thought I'd rather get something telling me than not," said Susan, who lives with herpes and runs the herpes support group HELP in Manchester, Conn.

"But then, the first reaction was, is this for real or is this a sick joke from somebody?" said Susan, who asked that ABCNews.com not use her full name.

Opinions may vary about the e-cards, but the trend is growing, according to a study by the site's creators in the Internet Sexuality Information Services online journal.

A Growing Trend

Since the site's launch in 2004, more than 30,000 people have sent a total of more than 49,500 e-cards. Inspot.org has been adapted by eight major metropolitan areas, nine states, and two international areas (including Romania) for both homosexual and heterosexual couples.

"It's kind of like the e-vite for party notifications, but this is for STD notifications," said Dr. Jeffrey Klausner of the San Francisco Department of Public Health.

It was Klausner who approached the technology-savvy public health group I.S.I.S. Inc. in the early 2000s to help him develop the site.

"In 1999, I discovered an outbreak of syphilis related to an AOL chatroom," Klausner said. Just a year before, San Francisco had eight cases of syphilis a year. By the end of 2004, Klausner said, the city had 550 reported cases.

After tracing the outbreaks to the chatroom, Klausner and colleagues at I.S.I.S. Inc decided to use the same type of communication that facilitated the hook-ups to help resolve the situation.

Using Technolgy For STDs

"We were seeing these things and thought there must be a way we can use technology as a means of prevention, not just a transmission tool," said Deb Levine, the executive director of I.S.I.S. Inc.

According to Levine and Klausner's survey of 833 gay men and men who had had sex with other men in San Francisco, 73 percent would recommend sending an anonymous e-card if they had to notify past partners about STDs.

Levine said focus groups in Philadelphia and Indianapolis indicated that the e-cards might be a good idea for heterosexual people, too.

But, Susan, who estimates she has counseled or spoken with more than 1,000 people diagnosed with herpes in Connecticut, isn't so sure.

"In general, we in the office thought, 'Oh -- it's kind of a way of telling somebody,'" she said. "The next thought would be, 'Would I just delete this or would this drive me crazy because who could this possibly have been from?'

"If somebody doesn't care enough to tell me in person, then it's kind of a slap in the face," she added.

How You Disclose an STD Matters

Gail Wyatt, a clinical psychologist, sex therapist and professor in the department of psychiatry and biobehavioral sciences at the University of California in Los Angeles, couldn't agree more.

"It would be very psychologically damaging to someone who thought they had a relationship with an individual and then they end up with an e-mail like this," said Wyatt. "I think they're sarcastic, I think they're making light of a very serious situation."

Yet, Wyatt understands why people would choose an e-card to tell their partner. She said much of the problem with spreading STDs, and with treating them, revolves around stigma.

"There's no real protocol for how to discuss sex in our society, so usually people don't talk about their STD history," Wyatt said. "They usually assume, and they're right sometimes, that they'll be discriminated against. ... So people usually keep it private until it's discovered."

Despite that stigma, Wyatt thinks the best way to tell a person about an STD is the old fashioned way: in person.

Reducing the Stigma of STDs

"The best way to disclose it, I think, is to call the person and ask to speak with them," Wyatt said. "Don't leave messages, or leave e-mails that could be looked upon by somebody else ... and I think some feelings of compassion should be expressed."

When it comes to stigma, Betsy O'Rourke, a registered nurse and the American Social Health Association herpes message board moderator, thinks people might do better to relax, especially when it is a non-fatal disease.

"You go to the grocery store and somebody's coughing all over your change and you get sick a couple of days later ... or you go to a locker room at a gym and get a wart on your foot and you say, 'oh, well,'" she said.

"You think you have sex -- and you're naked, sweating and exchanging body fluids -- and you don't think you're going to get sick?" O'Rourke said.

Given her experience moderating the herpes chatroom, O'Rourke said she sees tremendous potential in the anonymous cards.

"I think they're absolutely wonderful," she said. "One of the most popular questions I get on the board, is 'How do I talk with partner ... I wish (the e-cards) would be more widespread."

Although the Inspot.org site is catching on, and I.S.I.S. is working on a national database of testing clinics to expand the service, Klausner said the idea of a third party notifying past partners is nothing new.

"Since 1930, by law, all public health departments have inquired and notified past partners of people with confirmed cases (of STDs)," he said. "Unfortunately, over the past few years, the resources to do this have disappeared."

STI Awareness Only Goes So Far

While funding has dropped, STDs numbers have certainly remained steady. According to Klausner, 10,000 cases of syphilis are reported each year in the United States, and 50,000 cases of HIV infections are reported.

Those numbers may be small enough for public health departments to notify past sexual partners, but Klausner said the magnitude of other diseases is overpowering: 300,000 cases of gonorrhea a year and 1 million cases of Chlamydia reported, with a likely 2 million more unreported.

To Klausner, an e-notification site only addresses a small fraction of the awareness problem, and an even smaller fraction of the larger problem of STD transmission.

"Awareness is a piece of this, but because many of these infections people have but don't know it, it's really about screening," he said.

Klausner said 80 percent of sexually transmitted infections are asymptomatic; so, many people unknowingly pass a disease even before the problem of stigma or embarrassments comes up.

"It's part of the 'hidden epidemic,'" he said.