February 14, 2019
2 min read

‘Intersecting epidemics’: Drug use doubles in women, straight men with syphilis

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The prevalence of methamphetamine, injection drug and heroin use more than doubled among women and straight men with primary and secondary syphilis in the United States from 2013 to 2017, as did the prevalence of sex with an individual who injects drugs, study findings published in MMWR showed.

Researchers from the CDC’s Division of STD Prevention said the results were illustrative of the “intersecting epidemics” of heterosexual syphilis and drug use.

According to the report, the researchers used the National Notifiable Diseases Surveillance System to collect data on primary and secondary syphilis that were gathered by local health departments. The data contained demographic information and risk factors, including drug use and sexual partners from the previous 12 months.

Study results showed that from 2013-2017, primary and secondary syphilis rates among women increased 155.6% (from 0.9 to 2.3 cases per 100,000 women). The increase in all men was 65.7% (from 10.2 to 16.9 cases per 100,000 men), with a high prevalence noted in men who have sex with men (MSM).

Reported methamphetamine use in individuals with primary and secondary syphilis increased from 6.2% to 16.6% in women and from 5.0% to 13.3% among men who have sex with women (MSW) but decreased from 9.2% to 8% in MSM.

Patients with primary and secondary syphilis who reported having sex with a person who injects drugs increased from 5.5% to 12.4% in women and 3.6% to 9.3% in MSW and increased only slightly in MSM, from 4.3% to 5.2%, the researchers reported.

The percentage of people with primary and secondary syphilis who injected drugs increased from 4% to 10.5% in women, from 2.8% to 6.3% in MSW and remained at 3.5% in MSM, according to the study. Those with primary and secondary syphilis who reported heroin use increased from 2.1% to 5.8% in women and from 0.8% to 2.7% among MSW, whereas the proportion remained stable in MSM with an increase from 0.7% to 0.8%.

“These findings indicate that a substantial percentage of heterosexual syphilis transmission is occurring among persons who use methamphetamine, inject drugs or have sex with persons who inject drugs, or who use heroin, and that heterosexual syphilis and drug use are intersecting epidemics,” the researchers wrote. “A linkage between heterosexual syphilis and drug use has been observed previously. In the late 1980s and early 1990s, increases in heterosexual syphilis were associated with crack cocaine use.”


To address the increase in cases of heterosexual syphilis, the researchers recommend that STD control programs and substance abuse services collaborate to connect patients to clinical and prevention services. – by Erin Michael


Kidd SE, et al. MMWR Morb Mortal Wkly Rep. 2019;doi:10.15585/mmwr.mm6806a4.

Disclosures: The authors report no relevant financial disclosures.