XPost: can.politics, alt.society.mental-health, alt.politics.homosexuality   
   XPost: rec.sport.tennis, alt.global-warming   
   From: remailer@domain.invalid   
      
   Weekly / February 15, 2019 / 68(6);144–148   
      
   Sarah E. Kidd, MD1; Jeremy A. Grey, PhD1; Elizabeth A. Torrone,   
   PhD1; Hillard S. Weinstock, MD1 (View author affiliations)   
      
   View suggested citation   
      
   Summary   
   What is already known about this topic?   
      
   During 2013–2017, the primary and secondary (P&S) syphilis rate   
   increased 72.7% nationally and 155.6% among women.   
      
   What is added by this report?   
      
   During 2013–2017, reported methamphetamine, injection drug, and   
   heroin use increased substantially among women and heterosexual men   
   with P&S syphilis.   
      
   What are the implications for public health practice?   
      
   Heterosexual syphilis transmission and drug use, particularly   
   methamphetamine use, are intersecting epidemics. Collaboration   
   between sexually transmitted disease control programs and substance   
   use disorder services providers will be essential to address recent   
   increases in heterosexual syphilis transmission. Linking syphilis   
   patients with substance use disorders to behavioral health services   
   and providing syphilis screening for persons receiving substance use   
   disorder services are needed to address these co-occurring   
   conditions.   
      
   During 2013–2017, the national annual rate of reported primary and   
   secondary (P&S) syphilis cases in the United States increased 72.7%,   
   from 5.5 to 9.5 cases per 100,000 population (1). The highest rates   
   of P&S syphilis are seen among gay, bisexual, and other men who have   
   sex with men (collectively referred to as MSM) (2), and MSM   
   continued to account for the majority of cases in 2017 (1). However,   
   during 2013–2017, the P&S syphilis rate among women increased 155.6%   
   (from 0.9 to 2.3 cases per 100,000 women), and the rate among all   
   men increased 65.7% (from 10.2 to 16.9 cases per 100,000 men),   
   indicating increasing transmission between men and women in addition   
   to increasing transmission between men (1). To further understand   
   these trends, CDC analyzed national P&S syphilis surveillance data   
   for 2013–2017 and assessed the percentage of cases among women, men   
   who have sex with women only (MSW), and MSM who reported drug-   
   related risk behaviors during the past 12 months. Among women and   
   MSW with P&S syphilis, reported use of methamphetamine, injection   
   drugs, and heroin more than doubled during 2013–2017. In 2017, 16.6%   
   of women with P&S syphilis used methamphetamine, 10.5% used   
   injection drugs, and 5.8% used heroin during the preceding 12   
   months. Similar trends were seen among MSW, but not among MSM. These   
   findings indicate that a substantial percentage of heterosexual   
   syphilis transmission is occurring among persons who use these   
   drugs, particularly methamphetamine. Collaboration between sexually   
   transmitted disease (STD) control programs and partners that provide   
   substance use disorder services will be important to address recent   
   increases in heterosexual syphilis.   
      
   P&S syphilis case report data were extracted from the National   
   Notifiable Diseases Surveillance System, the system through which   
   CDC receives syphilis and other notifiable sexually transmitted   
   disease data from all 50 states and the District of Columbia. P&S   
   syphilis case report data include demographic information and also   
   risk factor information, such as information about sex partners and   
   drug use within the past 12 months, which is obtained through case   
   interviews or investigation by the local health department.   
      
      
   During 2013–2017, the percentage of persons with P&S syphilis who   
   reported methamphetamine use, sex with a person who injects drugs,   
   injection drug use, or heroin use within the past 12 months more   
   than doubled among women and MSW (Table 1). The percentage of   
   persons with P&S syphilis reporting methamphetamine use increased   
   from 6.2% to 16.6% among women, and from 5.0% to 13.3% among MSW,   
   but decreased from 9.2% to 8.0% among MSM. The percentage of persons   
   with P&S syphilis reporting sex with a person who injects drugs   
   increased from 5.5% to 12.4% among women and from 3.6% to 9.3% among   
   MSW, but increased only slightly among MSM (from 4.3% to 5.2%).   
   Injection drug use increased from 4.0% to 10.5% among women with P&S   
   syphilis and from 2.8% to 6.3% among MSW, but remained stable at   
   3.5% among MSM. Heroin use increased from 2.1% to 5.8% among women   
   with P&S syphilis and from 0.8% to 2.7% among MSW, but remained   
   relatively stable (increased from 0.7% to 0.8%) among MSM.   
      
   Among women with P&S syphilis, increases in methamphetamine use, sex   
   with a person who injects drugs, injection drug use, and heroin use   
   were observed in every region of the United States (Table 2). Among   
   MSW with P&S syphilis, the increase in sex with a person who injects   
   drugs was observed in every region, and the increases in   
   methamphetamine, injection drug, and heroin use occurred in all   
      
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