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“Facebook linked to a rise in syphilis” – no, it’s not.

March 24th, 2010

Dr Petra

Several papers carried the worrying story today suggesting links between social networking sites and sexually transmitted infections (STIs)
Facebook ‘linked to a rise in syphilis’ – Telegraph
Facebook ‘sex encounters’ linked to rise in Syphilis in North East – Metro
Sex diseases soaring due to Facebook romps – The Sun
Web casual sex sparks syphilis rise – Press Association

All of which sounds pretty scary. Are we really facing a syphilis epidemic linked to social networking? Where did the story come from? It seems to have been sparked by claims in the papers made by the Director of Public Health for Teeside, Professor Kelly, that the region has seen a rise of reported syphilis cases from 10 in 2008 to 30 by the end of last year.

According to press reports Professor Peter Kelly, claimed to have found a link between the rise in syphilis cases and young people using social networking sites. The details of how this was researched and measured have not been clearly reported. So it is unclear whether this is a health practitioner describing mapping of STIs to social behaviour; results of an epidemiological study on STIs in the North East; or speculation based on patient information that there could be a possible association between syphilis and using social networking sites. [A separate picture of sexual health in the NorthEast as compared with the rest of the UK that gives you an idea about the accuracy of these claims can be found here and a breakdown of regional data for STIs (including syphilis) is here - with thanks to Ben Goldacre]

Several papers document ‘research’ that indicates widespread social networking site use in the North East that’s higher than the UK average. Although it is not completely clear where this evidence comes from. Is it data the papers have included, or the information Teeside PCT were using.

While syphilis is an STI that’s on the rise, we have to be careful with headlines like this. They may sound dramatic but the first rule of understanding potential links between behaviours and infections is to remember correlation is not the same as causation. Just because some young people do seem to be using social networking sites for meeting others for sex it doesn’t mean that is directly responsible for rising STI rates.

Health professionals are often panicked by media moral crusades and currently anxieties over social networking sites are running high. Young people do report using such sites as well as other mobile technologies. So understandably practitioners may well question about such behaviours during consultations and form the conclusion that social networking sites are the cause of many sexual health problems.

However, just having this opinion doesn’t mean it is true or directly linked and would need closer investigation. Consultant Matthew Greenall is currently trying to find out from Middlesborough PCT what research was undertaken by Professor Paul Kelly to inform his view that social networking sites and STIs are directly linked. NHS Middlesborough’s press release that seemingly started the media coverage states “Unprotected sex, especially with casual partners, is the biggest risk for syphilis. Social networking sites are making it easier for people to meet up for casual sex. It is important that people avoid high risk sexual behaviours and practise safe sex to protect themselves from sexually transmitted infections”. However, additional quotes within newspapers make a more specific link between syphilis and social networking sites – so it is unclear if additional interviews were given, or whether the Professor has been misquoted. Or whether the papers just made up additional quotes (hey, we know that happens). At this time a number of practitioners are investigating exactly what was said and what evidence there may be about risks posed by social networking sites to the youth of Teeside.

As the story spread across Twitter several bloggers questioned the accuracy of the story, beginning with Science Punk who spotted the piece first, through to Enemies of Reason and Dungeekin who both provided a satirical take on the media coverage of the story. Meanwhile My Sex Professor highlighted issues around syphilis using the story as an opportunity to reinforce health messages and Heresy Corner discussed the prevalence of syphilis and the claims made in this story. The excellent Tabloid Watch focus more specifically on the discrepancies between the statements from Prof Kelly (which seem to be more about safer sex) and the media scaremongering. Similar discussions also come from The Media Blog and Roy Greenslade at the Guardian (read the comments for this, NHS Teeside respond to criticise Greenslade but apparently not the Telegraph or Sun’s bad coverage).

Within the online discussions it became obvious the link between social networking sites and syphilis was questionable. In fact the whole story appeared flawed as it seemed to have accepted a practitioner’s concern about rising STIs but no clear measure that they were linked to social network use. [If it turns out this is not the case and there is robust data to support the claims I’ll update this blog accordingly]. Indeed even if young people are using such resources to set up meetings with other people which lead to sex, the problem is presumably about a lack of safer sex when they meet, rather than the hook up itself? This wasn’t clear from media coverage and it would be worrying if health practitioners were being judgemental about sexual behaviour. The issue is about unprotected sex, not who you sleep with (or how you get to meet them).

No breakdowns were offered in the research about who the 30 people were with syphilis. Were they all straight? Had they all contracted syphilis from social networking sites – and how was that proven? How was ‘using’ social networking sites defined and measured? Were there any other STIs that were also associated with social networking hook-ups? And how were these connections assessed?

We rarely expect the media to deconstruct a moral panic story, particularly if it is about social networks or sex. However on this occasion it seemed that as well as not fully investigating a story before spinning it into an STI crisis, the reportage deliberately misrepresented aspects of social networking sites.

Facebook was named as the cause of the syphilis outbreak, and yet if you read the statements from Professor Kelly Facebook is not mentioned. Social networking is described. So why did Facebook get the blame compared with other networking sites? Could it be the papers who were leading on the story are owned by Rupert Murdoch who in turn owns Myspace social networking site, who are a competitor of Facebook?

The take home message from this case is it seems to be an example of practitioners speculating on the cause of a rising STI rate, the media spinning this into a causally linked epidemic, and then further manipulating the story to have a pop at their rivals.

What’s lost in the case is the issue of syphilis itself. It is an infection that currently predominantly affects gay men (in the UK) but is on the rise in heterosexuals. It needs addressing as although we have worked hard to raise awareness of highly prevalent STIs like Chlamydia, the public may believe Syphilis is an infection of the past. And may have no idea what symptoms to look out for or how to prevent the infection.

Some have argued the attention the story has generated has also raised the profile of syphilis, so that’s a benefit of the poor media coverage. Indeed #syphilis has become a trending topic on twitter as a result. Unfortunately if the focus remains on poor media coverage or the myth that Facebook causes syphilis then the opportunity to raise sexual health awareness will be lost.

Let’s show social networking can do good as well as the often claimed evil. Find online coverage of this story and use the comments to highlight the suggested link is not concrete, the media coverage is scaremongering, but most importantly to share accurate information on syphilis prevention and symptom spotting. Then tell your friends to do the same.

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