The Emerging Intersection Between Injection Drug Use and Early Syphilis in Nonurban Areas of Missouri, 2012-2018

Area of Science:

• Public Health
• Epidemiology
• Infectious Diseases

Background:

• National syphilis rates are rising, particularly among individuals who inject drugs (PWID).
• Missouri mirrors this trend with increased early syphilis (ES), congenital syphilis, and PWID cases, notably in nonurban counties.

Purpose of the Study:

• To analyze trends in early syphilis (ES) cases in Missouri from 2012-2018.
• To investigate the association between drug use, geographic location, and sex partner characteristics in ES cases.

Main Methods:

• Examined disease intervention specialist records for ES cases in Missouri (2012-2018).
• Classified drug use as injection drug use (IDU) (opioid or methamphetamine) or non-IDU.
• Compared ES rates based on residence, sex of sex partner, and drug use patterns.

Main Results:

• ES rates in Missouri increased by 365%, with a 1170% rise in small metropolitan and rural areas.
• Nonurban areas showed a higher prevalence of ES cases linked to injection drug use (12%-15%) compared to urban areas (2%-5%).
• Women, particularly of childbearing age, represented an increasing proportion of ES cases (8.3%-21%), with a notable rise in IDU among rural women with ES (8.4%-21.1%).

Conclusions:

• The rise in syphilis in rural and small metropolitan areas necessitates enhanced, outreach-based sexual health services.
• Integrating harm reduction services and drug treatment resources into healthcare policy can address both syphilis and injection drug use health outcomes.