1. SURFING FOR SEX – HOW TO TRACE PARTNERS !! Allan Harrison Sexual Health Adviser Newcastle PCT SSHA Conference – September 2008 Newcastle upon Tyne Email: Allan.Harrison@newcastle-pct.nhs.uk

2. Rationale ► Reduce the incidence of Syphilis infection in the North East. ► Meet the objectives of the National Strategy for Sexual Health & HIV (2001). ► Make use of technology to increase the range of partner notification methods. ► Provide Index Patients with another method of anonymous partner notification. ► Reduce the number of “untraceable” contacts.

3. BASHH Syphilis Guidelines 2007 BASHH Guidance ► At least 60% of contactable partners should attend for screening and/or treatment. ► Although whilst this standard may be achievable in some settings it may not be in all. ► Screening in high risk venues may be appropriate.

4. BASHH Syphilis Guidelines 2007 Management of Sexual Partners ► All patients with a diagnosis of syphilis should have partner notification discussed. ► Of contactable sexual partners of patients and pregnant women with early syphilis 46-60% also have the infection. ► Many sexual contacts are met in anonymous sex venues which makes partner notification difficult. ► All patients should be offered ‘patient’ and ‘provider’ referral as methods of tracing contacts.

5. Newcastle Health Protection Agency 2008 Syphilis Cases 2003 to September 2008

6. Newcastle Health Protection Agency 2008 Untraceable Syphilis Contacts

7. Most Common Places for Meeting Sexual Partners ► Cruising Areas ► Saunas ► INTERNET

8. All screenshots are copyright of each website identified Websites Identified

9. Professionals Involved ► Health Adviser Team ► Health Protection Agency ► Service Manager ► Information Technology Manager ► Clinical Governance ► Information Governance

10. Protocol Development ► Regional meeting with HPA regarding number of untraceable contacts of syphilis. ► Consultation with the Health Adviser Team regarding the concept. ► Consultation with the IT Manager to ascertain feasibility of having websites unblocked. ► Production of proposed protocol. ► Proposed protocol sent to General Manager, IT Manager, Clinical Governance.

11. Protocol Development ► Green light given by General Manager, Clinical Governance & IT Manager. ► Gaydar was the only site unblocked initially. ► Health Adviser profile created. ► Decision taken not to inform ISP of reason for profile creation.  All profiles are reviewed by the website prior to membership being accepted (Gaydar terms & conditions of use).

12. Protocol Development ► Clinical Governance sent the protocol to Information Governance. ► Information Governance suggested some changes to the protocol - changes made. ► Protocol needed to be passed by the Information Security and Confidentiality Subgroup of N.O.T Information Governance Committee. ► Protocol may become a sub procedure of the PCO Email & Internet acceptable use policy.

13. Website Access Procedure ► Must be two Health Advisers using a pc in a non clinical setting.

14. Website Access Procedure ► Complete the ‘web access time sheet’

15. Website Access Procedure ► No identifiable patient/contact information is to be sent via website messaging system.

16. Website Access Procedure ► Send first message to contact profile: “Important health message for you, please call (name & position) on 0191 2195014.” ► Enter details on to ‘Call expected from contact’ board and add a review date of two days to yellow contact card.

17. Action on Received Messages ► Any messages received on Health Adviser profile: Not P.N. related P.N. related

18. Website Access Procedure ► If a message is received from a contact then reply with the following (no matter what their message says): “Hi, we have information to suggest that you may have been in contact with a treatable sexually transmitted infection which you may not be aware of. To ensure your confidentiality we are unable to provide any further details via this system. Can you please call the Health Advisers (names of Newcastle HA’s) at the GUM clinic, Newcastle General Hospital, Tel: 0191 2195014.” ► Enter details on ‘Call expected from contact’ board and add a review date of two days to yellow contact card.

19. Website Access Procedure ► Staff must not enter into a dialogue with contacts via the website.

20. CASE ONE CASE ONE ► Index Patient diagnosed as Early Latent Syphilis. ► Details given of 3 contacts to be traced via Gaydar. ► Messages sent via web to 2 contacts, 1 profile name not recognised. ► 1 contact attended another local clinic and screening was negative. ► 1 contact ignored both messages.

21. CASE TWO ► Index Patient had reactive HIV test at Newcastle ‘Fastest’ service (result confirmed on venous sample). ► Details of 5 contacts given to be traced via Gaydar. ► 3 contacts attended and HIV testing was negative. ► 1 contact attended the ‘Fastest’ service and had reactive HIV test (result confirmed on venous sample). ► 1 contact was untraceable.

22. CASE THREE ► Index Patient diagnosed with Late Latent Syphilis. ► Details of 9 casual contacts given for tracing via Gaydar website. ► 4 contacts had negative screening. ► 5 contacts did not respond to the Internet messages.

23. CASE FOUR ► Index Patient diagnosed with Early Latent Syphilis. ► Details of 3 casual contacts given to be traced via Gaydar. ► All 3 attended – 1 diagnosed with Early Latent Syphilis, 2 had negative screening.

24. CASE FIVE ► Index Patient diagnosed HIV positive at Newcastle GUM. ► Details of Ex RMP given to be traced via Gaydar website. ► Contact attended Newcastle Fastest service and had a negative test.

25. CASE SIX ► Index Patient diagnosed with Early Latent Syphilis. ► Details given of 5 casual contacts, but only one to be traced via Gaydar. ► 3 contacts had negative screen, 1 was informed of need to attend. ► Contact from Gaydar attended and was diagnosed with Early Latent Syphilis.

26. CASE SEVEN ► Index Patient diagnosed with Secondary Syphilis 2006. ► Details provided of 20 contacts that he had met via Gaydar website (IP provided Excel spreadsheet). ► PR granted for all, but only telephone numbers for 15. ► However only 13 were successfully contacted.

27. RMP E1A, C4E RMP D3 6 Contacts 5 Contacts 15 Contacts RMP A1, C4E

28. Retrospective P.R. of Case Seven ► Discussion with IP Consultant. ► Due to having profile names for 5 contacts we checked to see if the profiles were still active on Gaydar website. ► Only one was still an active profile. ► With permission from the IP contact was made with the ‘contact’ who attended Newcastle GUM.

29. Feedback ► Response from one contact to first message was – “What?” ► Following second message his response was –  “ Is this a joke, just seems like a very unprofessional way of getting your message across to someone. I know I used to work for the NHS and this isn’t normal practice at all.”

30. Feedback ► This contact did actually attend a local clinic and when he spoke to a Health Adviser he said: “ He was very upset as he did not know that this method of tracing people was being used by the NHS.”

31. Feedback ► Telephone call from contact in response to second website message:- ► “I explained the reason for the message and that this was a new service we are offering people as a method of partner notification. He stated he did not have a problem with being contacted this way and thinks it is a very good idea”.

32. Feedback ► This contact did state however that he was quite worried as to what the infection might be, so I did inform him that it was HIV that we were concerned about (agreed previously with IP), to which he stated:- “ That was fine as he knows what he has and has not done. But he had not met many men for sex from Gaydar but understood that I could not discuss the person who gave his details.”

33. Email: Allan.Harrison@newcastle-pct.nhs.uk Any questions ?