Women, Syphilis, and Drug Use: A Renewed Convergence

April 24, 2019 | Hazel D. Dean

Women’s health is again threatened by the convergence of syphilis and drug use. In 1988, the health risk was driven by the co-epidemics of crack cocaine and syphilis. Today, the threat again comes from syphilis, this time combining with the epidemics of methamphetamine, heroin, and other injection-drug use. To protect women’s health, we should rethink how we can address this syndemic (i.e., two or more health problems interacting synergistically) while drawing on the lessons learned from prior syphilis increases and from the longitudinal relationships between healthcare providers and people living with HIV.

Syphilis Worsens in the United States, Including for Women

A recent CDC study revealed that during 2013–2017, drug use more than doubled among heterosexuals with syphilis. Researchers analyzed self-reported risk behaviors among women and men who have sex with women (MSW) who were diagnosed with primary and secondary (P&S) syphilis, the most infectious stages of the disease. What they identified was a substantial spike in methamphetamine, heroin, and other injection-drug use.

For women with syphilis, use of these drugs increased in every region of the United States, with use notably highest in the West for both men and women. In addition, and also in the West, researchers noted that in the last 12 months, more than 1 in 3 syphilis cases (35%) among women and 1 in 4 cases (25%) among MSW involved methamphetamine use, and that 1 in 5 syphilis cases (21%) among women involved injection-drug use.

Meanwhile, across the nation, we face steep and sustained increases in sexually transmitted diseases (STDs), including syphilis. In 2017, more than 100,000 cases of syphilis were reported, including 31,000 cases of P&S syphilis. Rates are the highest they have been in 20 years. More recently, since 2013, rates of P&S syphilis have increased 73 percent overall, including 156 percent among women and 66 percent among men. Congenital syphilis, a threat to both mothers and babies, also continues to increase.

What Public Health Leaders and Treatment Centers Can Do

Strategic collaborations are needed to successfully address the intersecting epidemics of heterosexual-related syphilis and drug use. Health officials are leaders and have a unique ability to identify and support partnerships between STD programs and substance use disorder prevention and treatment programs, as well as harm reduction programs and other local community organizations that provide such services. Public health leaders can also encourage substance use disorder and harm reduction programs, along with other community-based organizations, to integrate screenings for syphilis and other STDs, link to treatment services when needed, promote safer sex practices, and distribute condoms. Likewise, they can encourage STD programs—including health department STD clinics and Disease Intervention Specialists—to integrate screening for substance use disorders and link to drug use prevention and treatment services when needed.

The hard-won lessons from successfully connecting people living with HIV to sustained treatment can be applied to this problem. As with that epidemic, collaborating strategically and integrating disease and drug treatment services are ways that we can help to defeat these intersecting epidemics. Such service integration can move us toward the more holistic care our patients and clients need—care that takes us beyond STD diagnosis and treatment to considering who a person is, the circumstances they face, and how those circumstances affect their risks for both disease and substance use. This care is especially important for women who might not recognize their infection and face the additional risk of transmitting syphilis to their newborns.