Moreover, the strongly held right to privacy of information accessible through the Internet precluded us from directly learning the identity of partners through the Internet service provider (ISP).This article describes the syphilis outbreak and the case-control methods used to establish that meeting partners through the Internet was strongly associated with acquisition of syphilis.We also report our strategies for performing partner notification and increasing community awareness through the Internet without violating privacy concerns.

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Author Affiliations: San Francisco Department of Public Health (Drs Klausner and Katz and Mss Wolf, Fischer-Ponce, and Zolt) and Department of Medicine, Division of AIDS and Oncology, University of California, San Francisco (Drs Klausner and Katz); and the National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga (Ms Wolf).

Context A recent outbreak of syphilis among users of an Internet chat room challenged traditional methods of partner notification and community education because locating information on sexual partners was limited to screen names and privacy concerns precluded identifying sexual partners through the Internet service provider.

Objectives To determine the association of Internet use and acquisition of syphilis and to describe innovative methods of partner notification in cyberspace.

Design, Setting, and Patients Outbreak investigation conducted at the San Francisco (Calif) Department of Public Health (SFDPH) in June-August 1999 of 7 cases of early syphilis among gay men linked to an online chat room; case-control study of 6 gay men with syphilis reported to SFDPH in July-August 1999 (cases) and 32 gay men without syphilis who presented to a city clinic in April-July 1999 (controls).

Main Outcome Measures Association of syphilis infection with Internet use, Internet use among cases vs controls, and partner notification methods and partner evaluation indexes.

Results During the outbreak, cases were significantly more likely than controls to have met their sexual partners through use of the Internet (67% vs 19%; odds ratio, 8.7; = .03).We notified and confirmed testing for 42% of named partners; the mean number of sexual partners medically evaluated per index case was 5.9.Conclusions In this study, meeting sexual partners through the Internet was associated with acquisition of syphilis among gay men.Public health efforts must continually adapt disease control procedures to new venues, carefully weighing the rights to privacy vs the need to protect public health.Traditionally, health departments identify sexual partners through interviews with case patients and notify their partners by telephone, personal contact, or mail.Health departments have also been successful in modifying these techniques for situations in which partners are primarily anonymous.