The recent
syphilis epidemic in the United States has been linked to
cocaine abuse. The goal of this study was to estimate the prevalence of newly diagnosed
latent syphilis, as well as previously treated
syphilis, in emergency department patients giving a history of
cocaine use. Charity Hospital emergency department patients without symptoms of
sexually transmitted disease (STD) who admitted to
cocaine use were enrolled and screened for
syphilis with the automated
reagin test (ART). Patients were questioned about past
syphilis episodes, sexual behavior, and
drug use patterns. Reactive ARTs were confirmed with the microhemagglutination antibody to Treponema pallidum (MHA-TP) or the fluorescent treponema antibody-absorbed (FTA-ABS) test. Additionally, treponemal tests were performed in 68 of 79 ART-negative patients. Twenty-four women and 78 men were included in the sample over the 6-month period from December 1989 through May 1990. Of those enrolled, 64% used crack, only 24% were exclusively intravenous users, and 6% were exclusively nasal users. The remaining 6% utilized multiple routes of
drug administration. Nine
latent syphilis patients (8.8%) were diagnosed and an additional 20 (19.6%) patients were found to have had previous
syphilis. Among the 24 women studied, 5 (20.8%) had
latent syphilis. Fifty-eight percent of women had either latent or previously treated
syphilis as compared to 19% of men (P = 0.0006). These data suggest that elicitation of a history of
cocaine use from urban hospital emergency department patients may be helpful in identifying patients with
latent syphilis. Detection and treatment of latently infected women in this setting could prevent a significant number of
congenital syphilis cases.