Document 0670
 DOCN  M9480670
 TI    Recent changes in the epidemiology of genital ulcer disease in the
       United States. The crack cocaine connection.
 DT    9410
 AU    Martin DH; DiCarlo RP; Louisiana State University School of Medicine,
       New Orleans.
 SO    Sex Transm Dis. 1994 Mar-Apr;21(2 Suppl):S76-80. Unique Identifier :
       AIDSLINE MED/94317088
 AB    The incidence of syphilis and chancroid began to increase in the United
       States among heterosexuals in the mid-1980s, with most cases reported
       among minorities living in Eastern cities and in the South. A number of
       studies have established a link between increasing syphilis incidence
       rates and cocaine use, specifically the smoked form of the drug, which
       is known as crack. A similar link was hypothesized for chancroid, but
       supporting data became available only recently. In New Orleans, we
       showed that Haemophilus ducreyi infection in male patients was strongly
       associated with crack cocaine use. However, our studies also
       demonstrated that drug use by the patient actually was a marker for a
       more important risk factor: sexual exposure to a cocaine-using woman.
       Thus, although the details of the relationships among crack, sexual
       behavior, and the size and nature of core transmitter groups are not
       known, it is clear that crack cocaine abuse is the driving force behind
       the recent syphilis and chancroid epidemics in the United States.
       Although it is not possible to predict the effects of these events on
       human immunodeficiency virus (HIV) transmission, the potential for
       significant synergism between them exists. New approaches to HIV
       surveillance should be developed taking this possibility into account.
       During the last 3 to 4 years, incidence rates of syphilis and chancroid
       have fallen in the United States, despite continued problems throughout
       the country with crack cocaine abuse. However, our studies and those of
       others have shown how difficult it is to recognize chancroid clinically,
       suggesting that the disease may be grossly underreported.(ABSTRACT
       TRUNCATED AT 250 WORDS)
 DE    Chancroid/*EPIDEMIOLOGY/*ETIOLOGY/TRANSMISSION  *Crack Cocaine  Female
       Human  HIV Infections/*EPIDEMIOLOGY/*ETIOLOGY/TRANSMISSION  Incidence
       Male  Minority Groups  *Population Surveillance  Primary
       Prevention/METHODS  Risk Factors  Sex Behavior  Substance
       Dependence/*COMPLICATIONS  Syphilis/*EPIDEMIOLOGY/*ETIOLOGY/TRANSMISSION
       United States/EPIDEMIOLOGY  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

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