Download Guide to Sexually Transmitted Disease Resources on the

SURFING THE WEB
INVITED ARTICLE
Victor L. Yu, Section Editor
Guide to Sexually Transmitted Disease Resources
on the Internet
Andreas Tietz,1,a Stephen C. Davies,2 and John S. Moran3
1
Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, Louisiana; 2Sutherland Hospital, Sydney, Australia; and 3Centers
for Disease Control and Prevention, Atlanta, Georgia
The Internet provides patients, clinicians, teachers, and researchers with immediate access to reliable information, authoritative
recommendations, and the latest research findings and statistics, but quickly finding the best sources while avoiding the
unreliable and obsolete can be a problem. We searched the Internet for the most useful English-language Web sites on
sexually transmitted diseases (STDs), with annotations, in 4 tables: sites for patients, for clinicians and teachers, and for
researchers, and sites dedicated to a single STD. In the process, we found that government-sponsored sites tended to have
the most reliable information. This held true regardless of the kind of information we were seeking. Several universitysponsored sites contained information that was outdated or erroneous. Commercial and nonprofit sites sometimes evinced
a bias that could mislead some readers. Both health care professionals and laypersons seeking information about STDs on
the World Wide Web should generally start their search at government-sponsored sites.
The Internet can aid clinicians who treat patients with sexually
transmitted diseases (STDs) and the patients themselves by
making information on STD prevention, diagnosis, and treatment readily available, at little cost, to anyone with Internet
access. A diligent consumer can, for example, find descriptions
of STD symptoms and signs, and a health care professional can
access authoritative and up-to-date treatment recommendations, which spares the expense of keeping updated references
on hand.
MATERIALS AND METHODS
We began our search of the World Wide Web for STD information in 2001 and expanded it from April 2002 through September 2003; we used 20 popular and scientific Web search
and meta–search engines (1Blink, alltheweb, AltaVista, AOL
Search, Ask Jeeves, Dogpile, ExactSeek, Excite, Google, Lycos,
Mamma, MSN Search, Overture, Profusion, Scirus, Teoma,
Received 30 December 2003; accepted 4 January 2004; electronically published 15 April
2004.
a
Present affiliation: Division of Hospital Epidemiology, University of Basel, Switzerland.
Reprints or correspondence: Dr. John S. Moran, Mailstop E-61, Centers for Disease Control
and Prevention, Atlanta, GA 30333 ([email protected]).
Clinical Infectious Diseases 2004; 38:1304–10
2004 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2004/3809-0018$15.00
1304 • CID 2004:38 (1 May) • SURFING THE WEB
Web Crawler, Web Wombat, WiseNut, and Yahoo), and we
searched using the phrases “sexually transmitted diseases” and
“sexually transmitted infections.” We examined the first 10 or
more sites returned by each search engine. We also searched
for sites about specific STD entities (e.g., vaginitis, herpes, and
syphilis) using STD names as search terms. For this, we used
only Google, because our initial search on the above-mentioned
search terms showed that it returned the largest proportion of
high-quality sites. Ask Jeeves, Scirus, and AOL Search also returned a large proportion of high-quality sites. We also examined selected sites linked to the sites found by the search
engines. We last reviewed all sites mentioned in this article in
November 2003.
We did not systematically use objective standards for assessing the Web sites that we found; our global judgments are
subjective. However, we did use benchmarks for assessing the
accuracy and completeness of information on each site for
clinicians and patients. For sites that listed gonorrhea treatments, one of us evaluated the listed regimens for their concordance with current mainstream treatment recommendations
that reflect recent changes in the distribution of antibioticresistant Neisseria gonorrhoeae. For sites with information about
genital herpes or genital papillomavirus infection, we looked
for statements indicating that asymptomatic individuals can
transmit infection.
Table 1.
Web sites that provide information for patients with sexually transmitted diseases (STDs).
Title
URL
Source and/or sponsor
Target group
Comments
Sexually Transmitted Diseases Facts &
Information
http://www.cdc.gov/nchstp/dstd/dstdp.html
Division of Sexually Transmitted Diseases, National Center for HIV, STD and TB Prevention,
CDC
General public
Accurate, up-to-date information on STDs, with
fact sheets (in the public domain) and many
CDC reports; extensive links
Sexually Transmitted Diseases Services
http://www.stdservices.on.net
Royal Adelaide Hospital, Government of South
Australia
General public
Information about STDs, with pictures, fact
sheets, downloadable brochures, and extensive links; comprehensive and easy to navigate
Healthy Women
http://www.healthywomen.org/content.cfm
National Women’s Health, Resource Center
Women
General issues on women’s health; supported by
the pharmaceutical industry
An Introduction to Sexually Transmitted
Diseases
http://www.niaid.nih.gov/factsheets/stdinfo.htm
Office of Communications and Public Liaison, Na- General public
tional Institute of Allergy and Infectious Diseases, NIH
Succinct, accurate, up-to-date fact sheets on
STDs, with extensive links section; in the public domain
MEDLINE plus Health Information: Sexually Transmitted Diseases
http://www.nlm.nih.gov/medlineplus/
sexuallytransmitteddiseases.html
US National Library of Medicine, NIH
General public
A page of links to STD news and to a wide variety of sites with STD information
Sex Files
http://www.sexfiles.co.nz/
Medimedia New Zealand
General public, General sexual health information from the Auckadolescents
land Sexual Health Service
Sexually Transmitted Disease Basics
http://www.thebody.com/safesex/stdbasics.html
Body Health Resources Corporation
General public
An HIV/AIDS site, with facts on common STDs
and good clinical photographs and extensive
links
Sexually Transmitted Infections:
The Facts
http://www.plannedparenthood.org/sti/
stis_index.html
Planned Parenthood Federation of America
Family
A family planning site with facts about most
STDs; also in Spanish
Teenwire warehouse. Home Page,
Infections and Diseases
http://www.teenwire.com/index.asp
Planned Parenthood Federation of America
Adolescents
A family planning site with facts about sexuality
and STDs that is designed to appeal to
adolescents
Sexually Transmitted Infections
http://www.playingsafely.co.uk/
Health Promotion England (sponsored by the
NHS/DH)
Adolescents
Reproductive health site for adolescents, with basic information on common STDs
The Steve Retson Project. Sexual health
on the World Wide Web
http://www.steveretsonproject.org.uk
Neil Baxter Associates, Glasgow
Gay men
A health site for gay men that includes basic information on STDs
Facts and Answers about STDs
http://www.ashastd.org/stdfaqs/index.html
American Social Health Association
General public
Professionally designed Web site with extensive
patient-oriented information
http://www.iwannaknow.org
http://www.iwannaknow.org/index.html
American Social Health Association
Adolescents
Similar to the previous entry but designed for
teenagers
Sexually Transmitted Diseases (STDs)
http://www.healthsquare.com/ftstd.htm
New Media Systems
General public
Family medicine site with large section on STDs
Sexually Transmitted Diseases (STD)
http://www.ci.nyc.ny.us/html/doh/html/std/
std.html
New York City Department of Health and Mental
Hygiene
General public
Comprehensive site with up-to-date information
for patients and health care professionals
Ask NOAH About: Sexually Transmitted
Diseases
http://www.noah-health.org/english/illness/stds/
stds.html
New York Online Access to Health
General public, Government-sponsored site with extensive links;
adolescents
in English and Spanish, recently updated
NOTE.
CDC, Centers for Disease Control and Prevention; NHS/DH, National Health Service/Department of Health; NIH, National Institutes of Health; TB, tuberculosis.
of special interest to researchers and teachers are listed in table
3. Educators will find especially useful the sites that post documents in the public domain, which can be duplicated without
copyright concerns. Many of these sites are also likely to be of
interest to clinicians, journalists, and policy makers as well.
Web sites of special interest. Web sites devoted to particular STDs—gonorrhea, human papillomavirus, and herpes (4
sites)—are listed in table 4. The quantity and quality of information found on these sites varies with the target groups addressed. The spectrum includes support groups (e.g., The
HerpeSite) and more scientifically oriented audiences (e.g., The
International Herpes Management Forum).
DISCUSSION
Figure 1. Screen capture of the home page of the Center for Disease
Control and Prevention’s Division of Sexually Transmitted Diseases Prevention (http://www.cdc.gov/nchstp/dstd/dstdp.html). The Web site includes links to a wealth of information on sexually transmitted disease
(STD) diagnosis (including a clinical slide set), epidemiology, treatment,
and prevention for both professionals and laypersons.
RESULTS
Web sites for patients. The sites that we judged to be reliable
and especially useful for patients with STDs (and for worried
healthy persons) are listed in table 1. These sites should also
be of use to physicians, teachers, and journalists. The Centers
for Disease Control and Prevention (CDC) site was listed first
because of its fact sheets, multitude of documents, and high
quality (figure 1). The Royal Adelaide Hospital site in Australia
provides information nearly as comprehensive and is more succinct and easier to navigate (figure 2). Many other sites provide
useful information. The CDC, National Women’s Health Resource Center, and National Institute of Allergy and Infectious
Diseases/National Institutes of Health Web sites are of particular interest, because they provide a wealth of accurate and upto-date information.
Web sites for clinicians and teachers. Web sites likely to
be of special interest to clinicians and teachers are listed in table
2. Most of these sites are likely to be of interest to researchers,
as well. Once again, the sites operated by governmental agencies
were among the most useful. Sites sponsored by pharmaceutical
companies were generally of high quality but tended to be
limited in scope and less likely to have extensive material in
the public domain. The Family Health International site is
unique because it provides an introductory yet relatively comprehensive course in STDs with an emphasis on prevention and
public health aspects that is designed for reproductive health
professionals and presented both as an online, self-study course
and as a complete set of teaching materials.
Web sites for researchers and teachers. Sites likely to be
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A very large number of Web sites offer information on STDs
to the general public. Many of these do not have health education of the public as their primary purpose but aim instead
to promote a product or viewpoint. Regardless of the primary
purpose of each Web site, only a minority of the sites provided
completely accurate and up-to-date information. Among errors
we found on sites aimed at laypersons in 2001 were a statement
that untreated bacterial vaginosis can result in kidney failure
and an admonishment to patients with gonorrhea to abstain
from intercourse after treatment until results of 2 cultures were
negative. The first error had been eliminated by November 2003
but the second persisted.
Persons seeking information would be well advised to first
search government Web sites, where they will find information
that is generally unbiased and reliable. They may need to search
Figure 2. Screen capture of the home page of the Royal Adelaide
Hospital Sexually Transmitted Diseases Service Prevention (http://
www.stdservices.on.net/). The Web site includes links to information for
both professionals and lay persons on sexually transmitted disease (STD)
diagnosis, epidemiology, treatment, and prevention, most of which is
presented in succinct outline form.
Table 2.
Web sites that provide information for clinicians and teachers about sexually transmitted diseases (STDs).
Title
URL
Source and/or sponsor
Comments
Sexually Transmitted Diseases Treatment
Guidelines 2002 (United States)
http://www.cdc.gov/std/treatment/
Division of Sexually Transmitted Diseases, National Center for HIV, STD
and TB Prevention, CDC
Comprehensive, evidence-based guidelines updated recently; in the public domain, guidelines
downloadable to PDA in HTML and PDF
format
HIV and Sexually Transmitted Infections
http://www.hpa.org.uk/infections/topics_az/hiv_and_sti/
default.htm
Health Protection Agency
Facts about STIs, including their epidemiology in
the United Kingdom; treatment guidelines
show slight differences from CDC guidelines
Canadian STD Guidelines 1998
http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/
std-mts98/index.html
Expert Working Group on Canadian
Guidelines for Sexually Transmitted
Disease
Comprehensive guidelines for diagnosis and
treatment reflecting the consensus of experts;
very similar in substance to US guidelines but
presented in HTML and PDF format
Sexually Transmitted Diseases
http://www.who.int/health-topics/std.htm
World Health Organization
The World Health Organization’s main page for
STDs, with access to fact sheets, epidemiology data, publications and management guidelines; updated 1999
Association for Genitourinary Medicine.
UK Clinical Effectiveness Guidelines
2002
http://www.agum.org.uk/guidelines.htm
Association for Genito Urinary Medicine
Evidence-based UK national STI guidelines; updated in 2002
Region III STD/HIV Prevention Training
Center
http://www.stdpreventiontraining.org/
Johns Hopkins School of Medicine, CDC,
and Baltimore Department of Health
Training Web site with access to newest CDC
guidelines and online clinical courses in the
northeastern United States
Seattle STD/HIV Prevention Training
Center
http://depts.washington.edu/seaptc/
Center for AIDS and STD at the University of Washington–Seattle and King
County STD clinics
Clinical practice guidelines, a practitioner’s handbook in PDF format, and image galleries;
guidelines updated in 2003
Sexual Health, HIV/AIDS and Hepatitis C:
Clinical Information
http://www.health.qld.gov.au/sexhealth/
clinical_information.shtml
Queensland Health Electronic Publishing
Service
A wealth of clinical information about STDs for
STD health care professionals, including management guidelines; updated in 2002
Diagnosis and Management of Sexually
Transmitted Diseases (including HIV
Infection)
http://www.stdservices.on.net/management/default.htm
Sexually Transmitted Diseases Service of
Royal Adelaide Hospital
Updated STD diagnosis and treatment guidelines
from the Royal Adelaide Hospital
International Union against STIs
http://www.iusti.org
International Union against STIs
Comprehensive site for clinicians and researchers, including 2001 European Guidelines for
treatment of STIs
Diseases and Disorders—Links pertaining
to Sexually Transmitted Diseases,
Bacterial
http://www.mic.ki.se/Diseases/C01.252.810.html
Karolinska Institute Library
A page of links to a large number of publications
and sites involving STDs
Sexually Transmitted Diseases
http://edcenter.med.cornell.edu/Pathophysiology_
Cases/STDs/STD_TOC.html
Weill Medical College of Cornell
University
Clinical educational site with large gallery of images of pathologic findings
Family Health International
A course on STDs designed for reproductive
health professionals, with an emphasis on prevention and public health aspects; presented
both as an online, self-study course and as a
complete set of teaching materials.
Contraceptive Technology and Reproduc- http://www.fhi.org/training/en/modules/STD/default.htm
tive Health Series. Sexually Transmitted
Diseases
NOTE.
a
a
CDC, Centers for Disease Control and Prevention; STI, sexually transmitted infection; TB, tuberculosis.
In late 2003, the Association for Genito Urinary Medicine (AGUM) merged with the Medical Society for the Study of Venereal Diseases to form the British Association of Sexual Health and HIV;
the AGUM Web site will be removed in mid-2004.
Table 3.
Web sites that provide information for teachers and researchers about sexually transmitted diseases (STDs).
Title
URL
Source and/or sponsor
Comments
http://www.cdc.gov/nchstp/dstd/dstdp.html
Division of Sexually Transmitted DisCDC reports and publications, information on current
eases, National Center for HIV, STD
CDC research and research funding, and links to other
and TB Prevention, CDC
sources of information at CDC and elsewhere; in the
public domain
Surveillance & Statistics
http://www.cdc.gov/nchstp/dstd/Stats_Trends/
Stats_and_Trends.htm
Division of Sexually Transmitted DisThe most comprehensive, accurate, and current data
eases, National Center for HIV, STD
available on the occurrence of STDs in the United
and TB Prevention, CDC
States; in the public domain
Sexually Transmitted Diseases
http://www.niaid.nih.gov/dmid/stds/
Division of Microbiology and Infectious Diseases, National Institute of
Allergy and Infectious Diseases,
NIH
Includes NIH news releases and reports as well as information on current NIH research and research funding;
in the public domain, recently updated
STD Sequence Databases
http://www.stdgen.lanl.gov/
Los Alamos National Laboratory Bioscience Division
DNA sequences of Neisseria gonorrhoeae, Chlamydia
pneumoniae, Chlamydia trachomatis, Mycoplasma
genitalium, Treponema pallidum, Ureaplasma urealyticum, human papillomavirus, and human herpesvirus
types 1 and 2
Sexual Health and Sexually Transmitted
http://www.hc-sc.gc.ca/pphb-dgspsp/std-mts/index.html
Infections Centre for Infectious Disease
Prevention and Control
Population and Public Health Branch
(formerly LCDC) of Health Canada
Statistics on STDs in Canada, as well as links to Bureau
of HIV/AIDS, STD, and TB publications and hotlines
PubMed Search page
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
United States Department of Health
and Human Services’ National Library of Medicine
Most complete source of high quality information for the
professional on all aspects of STDs through Medline
HIV and Sexually Transmitted Infections
http://www.hpa.org.uk/infections/topics_az/hiv_and_sti/
default.htm
Health Protection Agency, England
and Wales
Several illustrated reports on the surveillance of STDs in
the United Kingdom
WHO Sexually Transmitted Infections reference page
http://www.who.int/health_topics/sexually_transmitted_infections/en/
WHO
Reference page with links to fact sheets, publications,
surveillance data, WHO Initiative on HIV/AIDS and
Sexually Transmitted Infections, and UNAIDS
Sexually Transmitted Diseases Services
http://www.stdservices.on.net
Royal Adelaide Hospital, Government
of South Australia
Information and links on STDs and their epidemiology in
Australia
Alliance for Microbicide Development
http://www.microbicide.org
Alliance for Microbicide Development
Privately funded interdisciplinary site focusing on topical
microbicide research
1308
Sexually Transmitted Diseases Facts &
Information
NOTE.
CDC, Centers for Disease Control and Prevention; TB, tuberculosis; WHO, World Health Organization.
Table 4.
Especially good Web sites for particular topics related to sexually transmitted diseases (STDs).
Title
URL
Source and/or sponsor
Target group
General public
Comments
http://www.hpv.org.nz
The New Zealand HPV Project
Neisseria gonorrhoeae Gonorrhea
http://www.cdc.gov/ncidod/dastlr/
gcdir/gono.html
Division of AIDS, STD, and TB Laboratory Health care professionals
Research, National Center for Infectious Diseases, CDC
Technical information on N. gonorrhoeae,
including identification, typing, and antimicrobial susceptibility testing; in the
public domain
International Herpes Management Forum
http://www.ihmf.org
Cambridge Medical Publications
General public, health care professionals
A site dedicated to herpesvirus, with reviews, patient’s resources, links, and
research news; supported by the pharmaceutical industry
HerpeSite
http://members.aol.com/herpesite/
HerpeSite
General public
User support group for patients with
herpes
Information for clinicians on the Australian Herpes Management Forum site
http://www.ahmf.com.au
Australian Herpes Management Forum
General public, health care professionals
Information for patients, clinicians, teachers, and researchers; sponsored by the
pharmaceutical industry
American Herpes Foundation
http://www.herpes-foundation.org/
Center for Biomedical Communication
Health care professionals
Herpes-oriented site with information for
clinicians and researchers and links to
patient’s resources; offers CME-accredited online courses
1309
New Zealand HPV Project
NOTE.
Information on HPV for patients, also includes treatment guidelines; supported
by a pharmaceutical firm
CDC, Centers for Disease Control and Prevention; CME, continuing medical education; HPV, human papillomavirus; N. gonnorhoeae, Neisseria gonorrhoeae; TB, tuberculosis.
⭓1 site to find coverage that suits their reading level and provides the level of detail they desire. If they need detailed information that is unavailable at a government site, they can
seek what they need at university sites and sites of nonprofit
organizations. But they must be aware that they may run across
erroneous information and that they should verify information
found on the Internet with their health care professional or
another information source before acting on it.
Physicians and other health care professionals seeking information for their patients will also find that government sites
are excellent sources of patient-education material. Especially
valuable are those sites, such as the CDC, that post a wealth
of documents that may be freely copied and distributed to
patients because they are in the public domain.
For clinicians, the listed Web sites had a wealth of useful and
accurate information. Especially useful were the Government
sites, which generally included clinical guidelines, epidemiological data, and research reports.
Clinicians who infrequently treat patients with STDs need
access to up-to-date treatment recommendations appropriate
to their practice. In most cases, these will be national treatment
guidelines in the country in which they practice. Fortunately,
these treatment recommendations are posted on the Internet,
often in their original form at a governmental site and in
abridged forms at commercial sites. Guidelines that are available for download to a personal digital assistant are useful, but
we found only a small number of Web sites that offer such
features.
Researchers will find that the CDC, National Institutes of
Health, Medline Plus, and PubMed Web sites are excellent starting places. The other Web sites in table 3 should also be very
useful. Any search for hard-to-find information should also
include a search of the entire Web with one of the better Internet
search engines, such as Google.
Most of the STD sites not listed in the tables were “me too”
sites that duplicated information available elsewhere, but a discouraging number were sites that had information that was
biased, outdated, or simply wrong. One site of a respected US
university in 2001 included 3 treatments for gonorrhea—dox-
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ycycline, cefuroxime, and trimethoprim-sulfamethoxazole—
that were not recommended by the CDC for gonorrhea therapy
at that time. This was corrected by 2003.
Another main quality criterion is the recommendation for
the use of fluoroquinolones in the treatment of gonorrhea.
Government-sponsored sites referred to the CDC’s recommendation against using fluoroquinolones to treat patients who
acquired gonorrhea in Asia or the Pacific, including Hawaii,
long before this information was found on other sites. Such
technical information was not presented on most sites designed
for the public, which included a brief and general discussion
of antibiotic therapy that was usually followed—wisely—by a
recommendation to “consult your physician about the treatments best for you.” However, some of these sites did go beyond
their depth by attempting to provide general information about
STDs. According to one site, “[gonorrhea] is caused by the
bacteria Neisseria gonorrhea which causes inflammation of the
glands.…The bacteria grows and multiples in the warm moist
areas of the body.…If this infection spreads from the Bartholin’s
glands to the uterus, it is probable that the woman will contract
pelvic inflammatory disease (PID)” (http://www.sexinfo101.
com/st_gonor.shtml). “If chlamydia is not detected and treated
there may be serious complications. Advanced chlamydia can
cause infection of the appendix, heart and liver” (http://
www.sexinfo101.com/st_chlam.shtml). Fortunately, there did
seem to be a general trend toward more accurate information
between 2001 and 2003, as sloppily produced sites disappeared
and more-carefully produced sites were improved.
In summary, we found that the most reliable information
for the patient, the physician, and the researcher was available
at government-run health sites, whether in the United States
Canada, Europe, or Australia. The worst information tended
to be found at commercial sites, such as those promoting unproven remedies. Of intermediate quality were academic sites.
Acknowledgment
We thank Dr. Victor Yu for many helpful suggestions made
at every stage of the preparation of this article.