#3: A Historical Perspective to US Syphilis Reporting and the Recent Rise of Risky Behaviors Among Women with Syphilis

Abstract

Abstract Background Congenital syphilis is a vertically transmitted infectious disease with devastating consequences during the perinatal period, including stillbirth. On October 8, 2019, the CDC published a press release stating the urgent action needed to break the cycle of STD increases, including syphilis. The purpose of this study was to provide a brief historical perspective of syphilis coding, reporting, and monitoring system changes since 1992, discuss US syphilis incidence and trends, and assess risky behaviors among women with primary or secondary syphilis. Methods Quantitative data were obtained from CDC AtlasPlus, STD Surveillance 2018 report, and CDC Syphilis Surveillance Supplement 2013–2017. Results The possible association between risky sexual behaviors among reproductive-age women, such as the use of phone applications like Tinder, and increased rates of congenital syphilis have come into question. In 2017, risky behaviors reported by American women with syphilis were having sex while intoxicated (36.7%), having sex with an anonymous partner (21.8%), use of methamphetamine (16.6%), and having met a sex partner through the internet (11.6%). Women aged 35–39 were most likely to report of having sex while intoxicated (45.3%) followed by ages 25–34 (41.3%). Women aged 15–19 were most likely to meet a sex partner on the internet (16.7%). 22.6% of women reported the use of “other drug,” not categorized under “crack”, “poppers”, “cocaine,” “heroin,” “methamphetamine,” “injection drugs.” Furthermore, younger individuals were more likely to report the use of an “other drug” with increasing annual trends since 2013. Conclusion The highest reported risky behavior among women with syphilis was having sex while intoxicated. Unexpectedly, having met a sex partner on the internet was not among the highest reported risky behavior. Clarification of “other drugs” may be beneficial in understanding the risky behaviors among young women with syphilis. The correlation between risky sexual behaviors and drug use among reproductive-age women and increasing congenital syphilis rates warrants further investigation. A causal relationship between these two variables cannot be excluded until linked data are available, including further stratification of “other drug” categories.