Swiping Right to Track Sexually Transmitted Infections

In online dating, the first message you send to a match can instantly make or break the connection. Heather Meador has it down. Her messages aren't funny, charming or seductive. But they are thought-provoking and incredibly personal.

Meador, a public health nurse at Linn County Public Health in Iowa, is one of a growing group of public health workers using dating apps to contact people who might have been exposed to a sexually transmitted infection (STI). A decade ago, public health providers reached out to contacts the old-fashioned way: by phone. These days, few people pick up and take the call, and many don't respond to text messages.

"Traditionally, we tried reaching out via telephone and giving someone a call," Meador said. "That used to work. Then people stopped answering phones."

The workers then tried messaging on Facebook, but that's largely ineffective, too, partly because younger generations have left the metaverse in droves. Even emails and in-person notifications aren't feasible since many folks who've met on the apps don't know their partner's legal name, let alone their email, home address or workplace.

Approaching an attractive stranger is all but a thing of the past. Now people are more likely to swipe right on a prospective paramour from the comfort of their barstool—even if their interest is a few feet away. As a result, a screen name and profile may be all Meador and her cohorts have to go on.

How it works

When Meador and her colleagues receive notification of a positive STI test from a healthcare provider's office or lab, they first call the patient to ensure they've been appropriately treated and answer any questions. They also inquire about risk factors that might have contributed to the infection to see if they could benefit from preventive treatments, such as PrEP (pre-exposure prophylaxis). Sometimes they help to connect patients with resources to fulfill other needs, including housing or insurance. However, an increasingly important aspect of the interview is to ask the patient about their sexual partners so a nurse can notify them, Meador said.

"We will never give the original patient's information," she noted. "We won't tell anybody about who they had sex with. We won't identify gender. We will not identify locations and we won't identify time periods. What we need is just the information on how we can find these individuals so that we can notify them that they have been named as a close contact and we would like to offer them testing and treatment to help protect them and protect their health."

Meador explained that "tracers" obtain as much information as possible, including how the partners met and their contact details. Frequently—about 50 percent to 75 percent of the time, Meador estimated—the answer to both is an app.

The contact tracers use apps throughout the day, searching for potential contacts in their vicinity. This is particularly straightforward with apps such as Grindr and Tinder, which use geolocation to render potential matches in a user's vicinity. When a health department employee sees a contact, they send a message disclosing who they are and asking them to call.

"The messages we're sending out are still pretty benign because we don't know who will be reading that message," she said. "So it's usually, 'Hi, my name is Heather and I'm with Linn County Public Health and I need to talk to you about a personal matter. Can you please call me at this phone number?'"

Meador noted that message recipients are generally "very responsive" and call back, even if some are initially wary.

"It has been very helpful, and we have been able to find individuals by utilizing dating apps that we may not have been able to locate otherwise," she added. "Obviously, the overall goal is to make sure that individuals that have been in contact with a sexually transmitted infection are tested and treated so that we can stop the spread of the infection."

Elena Galindo, M.D., an adolescent medicine physician and fellow at Children's Hospital Los Angeles, has diagnosed and treated many patients with STIs and condones this new method, saying she understands the public health department's urgency and desire to reach as many people as possible. She's also aware that the field of public sexual health is significantly underfunded and demands creative solutions for efficiency and efficacy.

"This is a very important job," Galindo said. "A person can have an STI and not know it because they don't have symptoms or their symptoms are easily dismissed. For individuals with a uterus, these infections can pose a grave risk to the health of their reproductive organs, making it vital that they learn of a potential STI exposure in order to get timely testing and treatment.

"The use of dating apps to track STI spread, I believe, is an effective tracking method, given that millions of sexually active people use dating apps," she added. "In order to be successful at halting the spread of STIs, public health officials need to be able to successfully reach those potentially exposed, and it is easier to contact people on dating apps than it is to call or text them and get a response."

What's behind the STI epidemic

According to a report published in Frontiers in Public Health, the United States is experiencing an STI explosion, with reported cases increasing "significantly" in recent years. The number of cases of gonorrhea, syphilis and chlamydia—the three most common reportable sexually transmitted diseases (STDs)—has reached levels unseen in the past 50 years, according to the report. Meanwhile, established diseases are becoming more resilient to vaccines, while nontraditional transmissible infections like mpox continue to emerge.

The causes are multifactorial, according to health experts.

For one, Meador said, it's simply much easier to meet people than it was in the days before dating apps. Additionally, the perception of sexual activity has changed, thanks in part to better STI treatments.

"Some of the things that we hear now is, 'Well, I can take medication to help prevent me from getting HIV, so I don't need to worry about condom use,'" she said. "Or we'll hear, 'I can just get a shot if I get gonorrhea; it's not a big deal.' So it's a two-sided sword that we have better treatment options and treatment for individuals. However, we don't want to see these viruses and infections mutate or change where our medication modalities no longer work. This is something that we're quite worried about right now with gonorrhea."

Antibiotic-resistant gonorrhea—also known as "super gonorrhea"—has become more prevalent in many parts of the world and it's of "great concern," Meador said. In January 2023, two cases of super gonorrhea were reported for the first time in the U.S.

"It is imperative that when people are having sexual activity, they are still being cautious, still asking questions and still using condoms and lubricant, and that we get these infections treated as quickly as possible so that it's not spreading," Meador explained.

That statement met agreement from Jen Hecht, co-founder and director at Building Healthy Online Communities (BHOC), based in Richmond, California; Rosalyn Plotzker, M.D., M.P.H., assistant professor in the University of California, San Francisco, Department of Epidemiology and Biostatistics, and clinical faculty for the California Prevention Training Center; and James Miller, M.D., who practices at Monarch OBGYN in Wooster, Ohio.

Decreased condom use, combined with a lack of quality, comprehensive sex education in schools and insufficient public health funding, has significantly contributed to the problem, they said.

"Condom use has been on the decline for the past decade across all genders and sexual orientations," Plotzker said. "For example, in the latest DHHS Family Planning Annual Report, among males at family planning centers, condom use declined from 75 percent in 2011 to 42 percent in 2021."

As for lack of funding, experts said that's nothing new.

"Historically, we have always underfunded it," said Rebekah Horowitz, M.P.H., a senior program analyst in the HIV, STI and viral hepatitis program with the National Association of County and City Health Officials (NACCHO) in Washington, D.C. She said the stigma around sex and sexual health is one substantial and persistent factor.

Plotzker concurred, acknowledging it is likely incredibly difficult for communities and government entities to receive funding to combat the nation's concurrent health challenges, from cardiovascular disease and cancer to vaccine distribution and sexual health.

"They are all important and—from what I hear—all underfunded," she said. "To complicate matters, STIs are historically taboo and have disproportionately impacted groups with less societal power who are underserved by the government generally, [for example,] racial/ethnic minorities, LGBTQI+, those who are unstably housed, those with lower income. So, in addition to limited public health funding at baseline, [STDs] like syphilis, gonorrhea and chlamydia also might have lacked health advocacy power for that reason."

The COVID-19 pandemic exacerbated existing issues, experts said. In addition to overloading an already stressed healthcare system, it caused restricted access to services, including STI testing and treatment.

"While there has been a rise in certain STIs for several years, the pandemic plays a big role in the current statistical surge," Miller said. "During the pandemic, statistically, STIs were down. Those statistics may have been inaccurate with limited funding and concentration on STIs while the world was dealing with a pandemic. After the pandemic, restrictions lessened and there may have been a surge in initial sexual activity, but this is theoretical. What is real is the 'catch-up' that had to be played by healthcare systems and patients. Many patients were seen for their routine problems or routine screening visits. While the healthcare played catch-up, many patients may have already been infected with STIs and unknowingly infected their partners."

Galindo concurred and summarized the primary factors contributing to the STI explosion as "lack of access," including lack of access to quality, evidence-based, comprehensive sex ed, leading to a lack of knowledge about STIs and safer sex, as well as a lack of access to free, confidential testing and to healthcare generally.

These issues disproportionately affect marginalized communities, particularly people of color, due to structural, systemic racism, Galindo added.

"Sexual healthcare that's accessible in all senses of the word—cost, location, awareness, cultural appropriateness—is crucial," Plotzker said.

Are dating apps helping or hurting overall?

The impact of online dating on public sexual health is yet to be determined, experts said, but it's clear there are benefits.

"As an adolescent medicine physician, I believe that the dating app culture has been helpful for public health in the sense that it creates more opportunities for some people to make

connections with others," Galindo said. "Especially coming out of the pandemic where there was a sharp rise in feelings of loneliness and isolation, for some people, dating apps create an easy and accessible way for connections to be made."

Galindo said some dating apps allow users to share pertinent health information, such as their HIV status and COVID vaccination status, which is "awesome" from a public health perspective.

"This empowers open communication between potential partners and helps reduce stigma," she added.

"Dating app culture has definitely changed public health. I personally think it's still early to know—and not well studied yet—if the harms will outweigh the benefits, vice versa, or if they will balance out in the long run," Plotzker said. "For instance, dating apps may have simultaneously expanded sexual networks while providing a platform for rapid dissemination of public health messaging about STI prevention and awareness.

"For online culture, including dating apps, we tend to think of things in the short term, probably because the medium itself moves at a quick pace and is very transient," she continued. "A meme goes completely viral for a week or two, then a year later, people hardly ever see it anymore. But public health is the opposite. It takes the long view and watches changes that happen slowly over years, even decades. It takes a lot of patience to see what is a temporary blip—like a viral meme—and what is a real change in society."

What could dating apps do to help?

Whatever the lasting effect of dating apps, experts said companies can take measures to ensure they're on the right side of history. In addition to letting users specify their statuses, latest STI test dates and whether they use condoms or PrEP, apps can be integral in disseminating public health information, Hecht and Meador both agreed. This information includes public service announcements about safer sex, notifications of outbreaks such as mpox and meningitis, and details on where to get testing, condoms, PrEP and other services.

Many apps have cooperated with organizations such as Building Healthy Online Communities and public health departments to incorporate such features, according to Hecht and Meador.

"One of the other things we do is we also work with advertisers to advertise our services on many dating apps so that individuals know, 'Hey, you can come to our health department. We do testing. We do treatment. We do PrEP therapy. We have free condoms here. We do harm-reduction services,'" Meador said. "So [we're] trying to let people know that we're here to help them."

BHOC and many public health departments, including Linn County's, provide free at-home STI testing kits, which are advertised on some dating apps. BHOC also developed a website, tellyourpartner.org, to allow people to anonymously notify partners of their STI status.

Of course, more can be done.

Horowitz suggested companies do a better job of facilitating disease investigation and outreach. Hecht recommended apps that would allow all users to have the unlimited ability to block people they don't want access to, citing research that says mistreatment correlates with an increased sexual health risk.

"Ultimately, STI prevention involves empowering individuals to make healthy decisions about their sexual lives and having accessible resources to actualize those choices," Plotzker said. "The goal of public health is to provide the infrastructure for that to happen. Cooperating with dating apps has played an important role already. Building Healthy Online Communities is a great example."