Implications of high prevalence of recreational drug use among cases of infectious syphilis: insights from state-wide surveillance data, South Australia, July 2022 – September 2023
DOI:
https://doi.org/10.33321/cdi.2025.49.049Keywords:
syphilis, surveillance, re-emerging disease, sexually transmitted disease, infectious disease, drug use, methamphetamine, AustraliaAbstract
Background
Both injecting drug use (IDU) and drug use by non-injecting routes only (non-IDU) are recognised internationally as behavioural risk factors for syphilis. In Australia, this association has predominantly been assessed in sexual health services. To generate evidence supporting regular screening and timely symptomatic testing of all at-risk populations, South Australia in 2022 commenced routine collection of drug use information for statutory syphilis surveillance.
Methods
We analysed reported IDU and non-IDU for all cases of infectious syphilis notified during the period 1 July 2022 – 30 September 2023 by demographic, clinical, and diagnosing provider characteristics. We used descriptive analyses and univariable logistic regression to compare IDU cases and non-IDU cases separately to cases reporting no drug use.
Results
There were 450 notifications during the 15-month period. Among the 92% of notifications with available information, IDU was reported for 10% of cases and non-IDU for 17%. Drug use of any kind was more common among females, cases diagnosed outside specialist services, and heterosexual and bisexual cases. Differences by city versus regional or remote location and symptom status were less notable. Only the increased odds of IDU among females (odds ratio (OR): 2.8; 95% confidence interval (95% CI): 1.2–6.3) and the increased odds of either type of drug use among cases reporting sexual partners of a different sex (IDU: OR: 2.5; 95% CI: 1.2–5.3; non-IDU: OR: 3.0; 95% CI: 1.7–5.4) and of partners of both sexes for non-IDU (OR: 3.0; 95% CI: 1.4–6.6) reached statistical significance.
Conclusion
These data demonstrate a high prevalence of IDU and non-IDU amongst syphilis cases diagnosed outside sexual health services. Females and heterosexuals report drug use more frequently than men who have sex with men (MSM). In response, the correctional and drug and alcohol sectors have been engaged to increase routine screening and primary care providers alerted to recreational drug use as a risk factor for syphilis.
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References
Australian Government Department of Health and Aged Care. National Notifiable Disease Surveillance System: National Communicable Disease Surveillance Dashboard. [Website.] Canberra: Australian Government Department of Health and Aged Care; 2024. [Accessed on 15 May 2024.] Available from: https://nindss.health.gov.au/pbi-dashboard/.
Ong JJ, Bourne C, Dean JA, Ryder N, Cornelisse VJ, Murray S et al. Australian sexually transmitted infection (STI) management guidelines for use in primary care, 2022 update. Sex Health. 2023;20(1):1–8. doi: https://doi.org/10.1071/SH22134.
King J, McManus H, Kwon JA, Gray R, McGregor S. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual surveillance report 2024. Sydney: The Kirby Institute, University of New South Wales; 2024. [Accessed on 8 March 2025.] Available from: https://www.kirby.unsw.edu.au/research/reports/asr2024.
Government of South Australia Department of Health (SA Health). Congenital syphilis case review. A report on outcomes with recommendations for prevention and management of future cases. Adelaide: SA Health; May 2021. [Accessed on 15 May 2024.] Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/resources/congenital+syphilis+case+review+report.
Maxwell S, Shahmanesh M, Gafos M. Chemsex behaviours among men who have sex with men: a systematic review of the literature. Int J Drug Policy. 2019;63:74–89. doi: https://doi.org/10.1016/j.drugpo.2018.11.014.
Fairley TA, Hadler JL, Gunn RA. The syphilis epidemic in Connecticut: relationship to drug use and prostitution. Sex Transm Dis. 1990;17(4):163–8. doi: https://doi.org/10.1097/00007435-199010000-00003.
Rolfs RT, Goldberg M, Sharrar RG. Risk factors for syphilis: cocaine use and prostitution. Am J Public Health. 1990;80(7):853–7. doi: https://doi.org/10.2105/ajph.80.7.853.
Balshem M, Oxman G, van Rooyen D, Girod K. Syphilis, sex and crack cocaine: images of risk and morality. Soc Sci Med. 1992;35(2):147–60. doi: https://doi.org/10.1016/0277-9536(92)90162-j.
Kidd SE, Grey JA, Torrone EA, Weinstock HS. Increased methamphetamine, injection drug, and heroin use among women and heterosexual men with primary and secondary syphilis — United States, 2013–2017. MMWR Morb Mortal Wkly Rep. 2019;68(6):144–148. doi: https://doi.org/10.15585/mmwr.mm6806a4.
Reno H, Fox B, Highfill C, McKee A, Trolard A, Liang SY et al. The emerging intersection between injection drug use and early syphilis in nonurban areas of Missouri, 2012–2018. J Infect Dis. 2020;222(Suppl 5):S465–70. doi: https://doi.org/10.1093/infdis/jiaa056.
Smith AM, Ferris JA, Simpson JM, Shelley J, Pitts MK, Richters J. Cannabis use and sexual health. J Sex Med. 2010;7(2 Pt 1):787–93. doi: https://doi.org/10.1111/j.1743-6109.2009.01453.x.
Aung ET, Fairley CK, Ong JJ, Chen MY, Phillips TR, Tran J et al. Incidence and risk factors for early syphilis among men who have sex with men in Australia, 2013–2019: a retrospective cohort study. Open Forum Infect Dis. 2023;10(2):ofad017. doi: https://doi.org/10.1093/ofid/ofad017.
Carter A, McManus H, Ward JS, Vickers T, Asselin J, Baillie G et al. Infectious syphilis in women and heterosexual men in major Australian cities: sentinel surveillance data, 2011–2019. Med J Aust. 2023;218(5):223–8. doi: https://doi.org/10.5694/mja2.51864.
Government of South Australia Register of Legislation. South Australian Public Health Act 2011. [Legislation.] Adelaide: Government of South Australia; 24 May 2022. [Accessed on 8 March 2025.] Available from: https://www.legislation.sa.gov.au/lz?path=%2FC%2FA%2FSOUTH%20AUSTRALIAN%20PUBLIC%20HEALTH%20ACT%202011.
SA Health. Report of Notifiable Condition. Syphilis Infection or Related Death. [Downloadable reporting form.] Adelaide: SA Health; 2024. [Accessed on 8 March 2025.] Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/08e26045-3c5e-4f29-af49-df2367d11422/RNC_Syphilis+Notification+Form_November2024.pdf.
Government of Western Australia Department of Health (WA Health). STI screening recommendations for priority populations. [Webpage.] Perth: WA Health. [Accessed on 8 March 2025.] Available from: https://www.health.wa.gov.au/Silver-book/STI-screening-recommendations-for-high-risk-populations.
Analytics and Research Unit, Drug and Alcohol Services South Australia. Summary of Key Findings from the 2022-23 National Drug Strategy Household Survey. Adelaide: SA Health, Drug and Alcohol Services South Australia; March 2024. [Accessed on 8 March 2025.] Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/fcd8c706-b910-419c-b528-36992be993f0/Summary+of+Findings+from+the+2022-23+National+Drug+Strategy+Household+Survey.pdf.
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