Behaviors of crack cocaine users and their impact on early syphilis intervention

The impact of crack use on syphilis intervention was investigated by reviewing records of persons diagnosed with early syphilis when voluntarily attending County Health Department clinics in Detroit, Michigan and Dallas, Texas between August 1989 and August 1990. The sample was stratified and data were analyzed using multivariate techniques. Compared with men who did not use crack, male crack users were more likely to report having four or more sexual partners during their critical period for acquiring or passing on infection (odds ratio, OR = 4.33; 95% confidence interval, CI = 2.08, 8.99). Among men, having a large number of sexual partners during this period was associated with a lower percentage of contacts being examined (OR = 11.8; 95% CI = 2.91, 47.5). Among women, having four or more sexual partners during their critical period and a lower partner examination rate were both associated with crack use; crack use was strongly associated with exchanging sex for money or drugs. We conclude that crack use has the largest impact on syphilis intervention through its association with having large numbers of sexual partners.