{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:20:39Z","timestamp":1791354039826,"version":"4.3.1"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"Supplement_5","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The national rate of syphilis has increased among persons who inject drugs (PWID). Missouri is no exception, with increases in early syphilis (ES), congenital syphilis, and PWID, especially in nonurban counties.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Disease intervention specialist records for ES cases in Missouri (2012\u20132018) were examined. Drug use was classified as injection drug use (IDU) (opioid or methamphetamine) or non-IDU (opioid, methamphetamine, or cocaine). Rates were compared based on residence, sex of sex partner, and drug use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Rates of ES in Missouri increased 365%, particularly in small metropolitan and rural areas (1170%). Nonurban areas reported a higher percentage of persons with ES who used injection drugs (12%\u201315%) compared with urban regions (2%\u20135%). From 2012 to 2018, women comprised an increasing number of ES cases (8.3%\u201321%); 93% of women were of childbearing age. Increasingly more women in rural areas with ES also reported IDU during this time (8.4%\u201321.1%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>As syphilis increases in small metropolitan and rural regions, access to high-quality and outreach-based sexual health services is imperative. Healthcare policy to equip health departments with harm reduction services and drug treatment resources offers an opportunity to impact both syphilis increases as well as health outcomes associated with IDU.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiaa056","type":"journal-article","created":{"date-parts":[[2020,2,5]],"date-time":"2020-02-05T20:09:24Z","timestamp":1580933364000},"page":"S465-S470","source":"Crossref","is-referenced-by-count":25,"title":["The Emerging Intersection Between Injection Drug Use and Early Syphilis in Nonurban Areas of Missouri, 2012\u20132018"],"prefix":"10.1093","volume":"222","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4979-5492","authenticated-orcid":false,"given":"Hilary","family":"Reno","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branson","family":"Fox","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Washington University in St. Louis, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Highfill","sequence":"additional","affiliation":[{"name":"Bureau of HIV, STD, and Hepatitis, Missouri Department of Health and Senior Services, Jefferson City, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"McKee","sequence":"additional","affiliation":[{"name":"Bureau of Reportable Disease Informatics, Missouri Department of Health and Senior Services, Jefferson City, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Trolard","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Washington University in St. Louis, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen Y","family":"Liang","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA"},{"name":"Division of Emergency Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley P","family":"Stoner","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA"},{"name":"Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth E","family":"Meyerson","sequence":"additional","affiliation":[{"name":"Southwest Institute for Research on Women (SIROW), University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,9,2]]},"reference":[{"key":"2020090213230113800_CIT0001","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1007\/s10461-012-0276-0","article-title":"Non-injection and injection drug use and STI\/HIV risk in the United States: the degree to which sexual risk behaviors versus sex with an STI-infected partner account for infection transmission among drug users","volume":"17","author":"Khan","year":"2013","journal-title":"AIDS Behav"},{"key":"2020090213230113800_CIT0002","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.ypmed.2019.105779","article-title":"Sexual risk behaviors and STDs among persons who inject drugs: a national study","volume":"126","author":"Brookmeyer","year":"2019","journal-title":"Prev Med"},{"key":"2020090213230113800_CIT0003","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/00007435-199607000-00006","article-title":"History of sexually transmitted diseases infection, drug-sex behaviors, and the use of condoms among midwestern users of injection drugs and crack cocaine","volume":"23","author":"Siegal","year":"1996","journal-title":"Sex Transm Dis"},{"key":"2020090213230113800_CIT0004","volume-title":"Sexually Transmitted Disease Surveillance 2018","author":"Centers for Disease Control and Prevention","year":"2019"},{"key":"2020090213230113800_CIT0005","doi-asserted-by":"crossref","first-page":"144","DOI":"10.15585\/mmwr.mm6806a4","article-title":"Increased methamphetamine, injection drug, and heroin use among women and heterosexual men with primary and secondary syphilis - 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