Examining Trends in Substance Use Behaviors Among Women With Primary and Secondary Syphilis: United States, 2018-2023.

Abstract

<b>Objectives.</b> To examine recent trends in substance use among women with primary and secondary (P&S) syphilis in the United States. <b>Methods.</b> We reviewed case notifications sent to the Centers for Disease Control and Prevention via the National Notifiable Diseases Surveillance System for women and girls aged 15 years and older with P&S syphilis from 2018 to 2023. We calculated percentages of behaviors associated with substance use during the past year (having sex while intoxicated or high, having sex with a person who injects drugs, or methamphetamine use) by year, race/ethnicity, and region. <b>Results.</b> Our analysis included 51 209 P&S syphilis cases. Most women and girls (86%) were of reproductive age. Behaviors were stable temporally and regionally, but methamphetamine use was highest in the West (30%). All behaviors were reported more frequently among non-Hispanic White women than non-Hispanic Black or Hispanic women. <b>Conclusions.</b> Although substance use behaviors were frequently reported, trends were stable, indicating that the proportion of women reporting these behaviors did not scale with recent national increases in P&S syphilis among women. Universal syphilis screening of reproductive age women and girls could be evaluated as an option to reduce syphilis among them along with adverse outcomes, including congenital syphilis. (<i>Am J Public Health</i>. 2025;115(12): 2044-2052. https://doi.org/10.2105/AJPH.2025.308254).