Internet treatment of sexually transmitted infections - a public health hazard?

Background: Owing to the stigma associated with sexually transmitted infections, patients may prefer to keep their illness private, and choose instead to try self-treatment remedies from the internet. However, such remedies may prove hazardous if the sellers do not provide detailed advice on adverse effects, or on avoiding transmission and re-infection. We conducted an internet search to determine the availability of treatments for STIs and the nature of information provided by vendors of these treatments. Methods: We conducted a systematic internet search using five different search engines in February 2007. The search term included the words "self treatment" and the name of six different common STIs. We visited the vendors' websites and recorded any information on the formulation, adverse effects, cautions, and prevention of infection. Results: We identified a total of 77 treatments from 52 different companies, most of which were sold from the UK and US. The available remedies were predominantly for topical use and consisted mainly of homeopathic remedies. Only a small proportion of the web-listed products gave details on adverse effects, contraindications and interactions (22%, 25% and 9% respectively). Similarly, web vendors seldom provided advice on treatment of sexual contacts (20% of chlamydia and 25% of gonorrhea treatments) or on preventive measures (13%). Conversely, evidence of effectiveness was claimed for approximately 50% of the products. Conclusion: While treatments for certain STIs are widely available on the internet, purchasers of such products may potentially suffer harm because of the lack of information on adverse effects, interactions and contra-indications. Moreover, we consider the paucity of preventive health advice to be a serious omission, thereby leading to patients being needlessly exposed to, and potentially re-infected with the causative pathogens

Pills, pluralism, risk and citizenship: Theorising e-pharmacies

This article uses the theoretical concepts of risk, imagination and pharmaceutical citizenship to understand the growing popularity of e-pharmacies and online health-seeking. I start with discussing how rapid social and economic forces such as globalisation, the rise of diasporic communities, increased use of technologies, changing notions of citizenship and risk, and the commodification of health have see the rise of e-pharmacies both licit and illegal. Then I explicate the links between the social imagination and pluralism; the relationship between e-pharmacies, risk and the state; and finally how the aim of achieving pharmaceutical citizenship prevails over national citizenship and the risks associated with using e-pharmacies. I conclude there are three ironies in this paradigm: (i) the common reasons for drug-purchasing among e-pharmacy consumers (associated as being technologised, high income earners) and drug consumers in low-income, poorly regulated societies; (ii) the irony of pluralism and hybridism-wherein drugs are marketed as exotic and unknown but embedded in scientific knowledge and credibility; and (iii) the irony of risk and the role of the state-wherein people prefer the unknown, that is, the risk of drugs bought online rather than the risks of the known, that is, the capacity of the state to actually and sufficiently care for its populace