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It was actually one of the first published studies of a strong association between Internet sex partnering and syphilis transmission.

As part of that study, we continued to monitor the use of Internet chat rooms and Internet sites among syphilis case patients and non-patients seen at the STD clinic in San Francisco and how about half of new cases have met recent partners online and the Internet sites have continued to be a place where we focus prevention efforts.

I wanted to start the discussion more with evidence because there might be people who are skeptical or do not really understand what evidence there is out there that men who have sex with men and meet their sexual partners online have higher rates of unprotected sex and sexually transmitted diseases. We did a case-control study, which is kind of your typical type of evaluation to determine what risk factors are associated with cases and non-cases.

In this investigation, we found that 67% of these syphilis cases versus 19% of matched men who were non-syphilis cases had met recent partners in the chat room, and this was a statistically significant association.

But I really do think a lot of it is based on comfort level of perceived anonymity. I do not want to start off by blaming the Internet and saying, you know, "This medium is the reason that there are higher transmission rates." It is yet another way that men can meet men and a lot of the people who are meeting men on the Internet are also meeting men in bars and clubs and bath houses and parks and everywhere else. Adding to that, though, the Internet allows men to meet each other faster.

It is a lot cheaper to just go online and go to a chat room than to get up, go out of the house and go to a bar or a club or some other venue.Frank Strona: One of the things to keep in mind with Internet behavior is there is a perception of anonymity.It is a cultural norm to be able to put a photograph in the profile out there that does not have a face, it does not have a name associated and I think that there is a level of personal safety that you believe you have, giving the fact that you think people cannot identify you.Deb Levine is the Executive Director of Internet Sexuality Information Services, or ISIS, which has contracted with the City and County of San Francisco to provide syphilis elimination services to men who have sex with men in the City, and also to identify their partners on the Internet.ISIS has worked with online providers to provide online prevention initiatives. have documented high rates of unprotected sex among men recruited from online venues and there are several European studies that have looked at comparing, guys who say that they actually are using chat rooms to those that are not using chat rooms and there is a lot of information, a lot of data, showing that the chat room users are actually reporting higher rates of unprotected sex than the non-chat room users.