RT Journal Article SR Electronic T1 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 JF Sexually Transmitted Infections JO Sex Transm Infect FD BMJ Publishing Group Ltd SP 267 OP 272 DO 10.1136/sextrans-2018-053878 VO 95 IS 4 A1 Huichao Wu A1 Cuizhen Xiu A1 Xiaojing Fu A1 Menglong Li A1 Zhenhong Wang A1 Xiufang Li A1 Jing Wu A1 Sten H Vermund A1 Yifei Hu YR 2019 UL http://sti.bmj.com/content/95/4/267.abstract AB 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 .