COMMENTARY

STI Diagnoses Crowdsourced on Reddit: What Can We Learn?

F. Perry Wilson, MD, MSCE

Disclosures

November 06, 2019

Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I'm Dr F. Perry Wilson.

This week, the never-ending cornucopia of societal benefit that is social media overfloweth once more, as a study appearing as a research letter in JAMA examines the use of Reddit to diagnose sexually transmitted infections (STIs).

Many of you will be familiar with Reddit. But if not, it is, according to Alexa analytics, the sixth most popular website in the United States, just after yahoo.com, which I assume is due to being the default homepage on some browsers, and above Wikipedia.org, which maintains its rank mostly on the basis of my doing research for Impact Factor on Medscape.


 

Reddit is organized around forums, known as subreddits, where people can post thoughts, questions, or links to other sites. These posts are then up- or downvoted, so the crowd curates what is worth seeing. If you haven't tried Reddit before, I recommend the subreddit entitled "what's wrong with your dog." It's adorable.

Not quite as adorable is the subreddit called "STD," where people discuss STIs. A cursory glance at the top posts this week include gems like "Constant Urethral Burn," "Large Red Cyst," and "Plz Help." Many posts have pictures attached.

Researchers from University of California San Diego and Johns Hopkins downloaded all 16,979 posts on that subreddit from November 2010 to February 2019. You can see in this figure how the subreddit has gotten more popular over time.


 

They then took a random sample of 500 posts to determine what was being discussed. The majority (58%) were people asking for a diagnosis; 31% of those contained a picture to aid in the crowdsourced diagnosis. One fifth of those who wanted a diagnosis had already received a diagnosis from a doctor or other provider but wanted a second opinion. Impressively, almost every post got at least one response, and the median time to response was 3 hours. Eighty percent were answered in less than a day.

Of course, we have no idea whether the responses were remotely accurate, but given how long patients have to wait for a PCP visit, you can't beat those numbers.

I was curious, of course, so I dug into the subreddit a bit to get a feeling for what goes on there. Yes, there was a lot of asking for diagnoses, and a lot of pictures.

There was also a lot of anxiety and a lot of support.

Honestly, many of the suggested diagnoses were pretty accurate. But there were also some suggestions that were clearly wrong. And very few responses said what I think would be a no-brainer: "If you're worried, see a doctor."

And maybe that's the take-home here. The stigma of STIs makes seeing a doctor scary for lots of people. The anonymity of the Internet can be really attractive, even if the strangers giving you advice are anonymous too.

Okay, obviously Reddit is not the place you should go to get your STIs diagnosed, but it seems to me, as a physician, that we are missing a potential public health opportunity here. There are anonymous STI clinics in many states, but I have yet to see the Internet leveraged by health professionals to help anonymous patients cope with the anxiety surrounding STIs, to provide reassurance or—when appropriate—to say, "Seriously, go see a doctor."

F. Perry Wilson, MD, MSCE, is an associate professor of medicine and director of Yale's Program of Applied Translational Research. His science communication work can be found in the Huffington Post, on NPR, and here on Medscape. He tweets @methodsmanmd and hosts a repository of his communication work at www.methodsman.com.

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