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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
  1. Huichao Wu1,
  2. Cuizhen Xiu2,
  3. Xiaojing Fu3,
  4. Menglong Li1,
  5. Zhenhong Wang4,
  6. Xiufang Li5,
  7. Jing Wu6,
  8. Sten H Vermund7,
  9. Yifei Hu1
  1. 1 Child and Adolescent Health and Maternal Health, School of Public Health, Capital Medical University, Beijing, China, Beijing, China
  2. 2 Department of HIV/STD Prevention and Control, Qingdao Center for Disease Control and Prevention, Qingdao, China
  3. 3 Division of Biostatistics, School of Public Health and Management, Weifang Medical University, Weifang, China
  4. 4 Department of Dermatology, The Third Hospital of Chengyang, Qingdao, China
  5. 5 The Sex Center, The Affiliated Hospital of Medical College Qingdao University, Qingdao, China
  6. 6 School of Agroforestry and Medicine, The Open University of China, Beijing, China
  7. 7 Yale School of Public Health, Yale University, New Haven, Connecticut, USA
  1. Correspondence to Dr Yifei Hu, Child and Adolescent Health and Maternal Health, School of Public Health, Capital Medical University, Beijing 100069, China; huyifei{at}


Objective 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.

Methods 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.

Results 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).

Conclusions 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 .

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

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  • HW and CX contributed equally.

  • Handling editor Jackie A Cassell

  • Collaborators Huichao Wu; Cuizhen Xiu; Xiaojing Fu; Menglong Li; Zhenhong Wang; Xiufang Li; Jing Wu; Sten H. Vermund; Yifei Hu.

  • Contributors HY was the principal investigator and designed the study; HY, XC, FX, WZ and LX carried out the survey; WH, WJ and HY performed data analysis; WH and HY interpreted findings and drafted the manuscript; HY and SHV interpreted findings, edited and revised the manuscript. All authors had final approval of the submitted and published versions.

  • Funding HY is supported in part by Natural Science Fund Commission of China (H2609/81673232) and Beijing Education Commission (KM201810025009). SHV is supported in part by the Yale Centre for Interdisciplinary Research on AIDS supported by NIH grant (P30MH062294).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The study protocol was approved by the National Center for Disease Control AIDS Centre (NCAIDS, China CDC) Ethics Review Board (X130205268).

  • Provenance and peer review Not commissioned; externally peer reviewed.