Syphilis and substance use: Rising rates of syphilis in cisgender women
By Andrew Reynolds
In recent years, rates of syphilis have skyrocketed in the United States, and San Francisco has seen significant increases, too. Syphilis is a sexually transmitted disease, and it’s a sneaky little bug: Its called the “great imitator” because the symptoms can be hidden or hard to see, or they mirror symptoms of other diseases and conditions. Syphilis is pretty easy to treat with antibiotics, but if it goes unnoticed and untreated, it can lead to a host of serious medical problems.
In San Francisco, there has been a sharp spike in new infections among cisgender women: From 2017 to April, 2021 (last available data), SF saw a 190% increase from 62 to 180 cases, and most of these cases are found in women of childbearing age. Syphilis during pregnancy, also called perinatal syphilis, can lead to very serious complications in the baby, including stillbirth and infant death. If tested for and diagnosed, syphilis can still be treated during pregnancy and dramatically reduce or eliminate these risks.
Things that have been associated with syphilis in women include: unstable housing and homelessness; substance use (particularly methamphetamine use); sex work; sex in exchange for money, housing or drugs; intimate partner violence; a history of incarceration; sex with a partner who may be at risk for syphilis or HIV; and history of an STI in the past year.
We at SAS can play a key role in educating and preventing syphilis. We do not test for it at our mobile sites, but you can always refer people to the Harm Reduction Center, Tuesday to Friday from 11a-1p for syphilis screening. City Clinic is one of the best places in the United States for syphilis care and treatment, and Homeless Prenatal Program is an amazing organization that provides wrap-around services for pregnant and unhoused (or marginally house) women.
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