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Sex Transm Infect. 2019 Jun;95(4):267-272. doi: 10.1136/sextrans-2018-053878. Epub 2019 Mar 6.

Syphilis associated with recreational drug use, depression and high-risk sexual behaviour in men who have sex with men: a case-control study in China.

Author information

Child and Adolescent Health and Maternal Health, School of Public Health, Capital Medical University, Beijing, China, Beijing, China.
Department of HIV/STD Prevention and Control, Qingdao Center for Disease Control and Prevention, Qingdao, China.
Division of Biostatistics, School of Public Health and Management, Weifang Medical University, Weifang, China.
Department of Dermatology, The Third Hospital of Chengyang, Qingdao, China.
The Sex Center, The Affiliated Hospital of Medical College Qingdao University, Qingdao, China.
School of Agroforestry and Medicine, The Open University of China, Beijing, China.
Yale School of Public Health, Yale University, New Haven, Connecticut, USA.
Child and Adolescent Health and Maternal Health, School of Public Health, Capital Medical University, Beijing, China, Beijing, China
Contributed equally



We investigated syphilis prevalence among men who have sex with men (MSM) in China, as well as potential risk factors. Our principal hypothesis was that syphilis would be associated with the use of recreational drugs such as methamphetamines.


From April to October 2013, we used several methods to recruit MSM in Qingdao, collecting demographic/behavioural information via self-administrated questionnaires. Trained health workers collected blood for the Treponema pallidum particle assay (TPPA) with positives confirmed by a toluidine red unheated serum test. We used an unmatched case-control study to identify factors that might predict syphilis infection using multivariable logistic regression.


We recruited 447 MSM who agreed to participate and who completed syphilis testing. Of 71 (15.9%) syphilis-positive MSM, 44 (62.0%) used drugs. Of 376 (84.1%) syphilis-negative MSM, 186 (49.5%) used drugs. We found a positive association with syphilis for any recreational drug use (crude OR (cOR) 1.7, 95 % CI 1.0 to 2.8), frequent methamphetamine use (cOR 2.4, 95% CI 1.1 to 5.3) and multiple drug use (adjusted OR (aOR) 3.4, 95% CI 1.3 to 9.2). Syphilis-positive men were more likely to have a higher physical depression score (aOR 5.2, 95% CI 1.1 to 24.4), be > 30 years old (aOR 2.7, 95% CI 1.5 to 4.8), report a prior STI (aOR 4.1, 95% CI 2.3 to 7.3) and report a sex party experience (aOR 2.2, 95% CI 1.1 to 4.4).


Recreational drug use, depression and high-risk sexual behaviours were associated with syphilis infection among MSM in China. Only a multifaceted approach is likely be effective in control of both syphilis and HIV .


China; depression; men who have sex with men; methamphetamine; sexual behaviour; syphilis

Conflict of interest statement

Competing interests: None declared.

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