Examining Trends in Substance Use Behaviors Among Women With Primary and Secondary Syphilis: United States, 2018–2023

Objectives. To examine recent trends in substance use among women with primary and secondary (P&S) syphilis in the United States. Methods. We reviewed case notifications sent to the Centers for Disease Control and Prevention via the National Notifiable Diseases Surveillance System for women and girls aged 15 years and older with P&S syphilis from 2018 to 2023. We calculated percentages of behaviors associated with substance use during the past year (having sex while intoxicated or high, having sex with a person who injects drugs, or methamphetamine use) by year, race/ethnicity, and region. Results. Our analysis included 51 209 P&S syphilis cases. Most women and girls (86%) were of reproductive age. Behaviors were stable temporally and regionally, but methamphetamine use was highest in the West (30%). All behaviors were reported more frequently among non-Hispanic White women than non-Hispanic Black or Hispanic women. Conclusions. Although substance use behaviors were frequently reported, trends were stable, indicating that the proportion of women reporting these behaviors did not scale with recent national increases in P&S syphilis among women. Universal syphilis screening of reproductive age women and girls could be evaluated as an option to reduce syphilis among them along with adverse outcomes, including congenital syphilis. ( Am J Public Health. Published online ahead of print September 11, 2025:e1–e9. https://doi.org/10.2105/AJPH.2025.308254 )