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Lucy Platt, MSc, Tim Rhodes, PhD, Ali Judd, PhD, Evgeniya Koshkina, PhD, Svetlana Maksimova, PhD, Natalia Latishevskaya, PhD, Adrian Renton, MD, Tamara McDonald and John V. Parry, PhD

At the time of this study, Lucy Platt, Tim Rhodes, and Ali Judd were with the Centre for Research on Drugs and Health Behavior, Imperial College, London, England. Evgeniya Koshkina is with the Department of Epidemiology, National Centre for Research on Addictions, Moscow, Russian Federation. Svetlana Maksimova is with the Sociology Faculty, Altai State University, Russian Federation. Natasha Latishevskaya is with the Department of General Hygiene and Safeguard of Health, Volgograd Medical Academy, Volgograd, Russian Federation. Adrian Renton is with the Unit for International Public Health and Development, Imperial College, London. John V. Parry and Tamara MacDonald are with the Sexually Transmitted and Blood Borne Virus Laboratory, Health Protection Agency, London.

Correspondence: Requests for reprints should be sent to Lucy Platt, MSc, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England (e-mail: lucy.platt{at}lshtm.ac.uk).

Objectives. We examined risk factors for syphilis infection among injection drug users in 3 Russian Federation cities, focusing particular attention on the potential roles of gender and sex work.

Methods. We conducted a cross-sectional survey of injection drug users in Moscow, Volgograd, and Barnaul, collecting behavioral data and testing for antibodies to Treponema pallidum. Associations between presence of antibodies to T pallidum and covariates were explored.

Results. Overall, the prevalence of antibodies to T pallidum was 11% (95% confidence interval=9.7%, 13.1%). Syphilis was associated with involvement in sex work and with gender in Moscow and Barnaul but not in Volgograd. Female injection drug users not involved in sex work were more likely than men to be younger and to have recently begun to inject; female injection drug users involved in sex work were more likely than those not involved in sex work to inject daily.

Conclusions. Syphilis transmission dynamics varied by region. Sex work can increase syphilis risk among injection drug users, potentially feeding the momentum of sexually transmitted HIV and syphilis among noninjectors. Targeted interventions are needed to reduce both sexual and injection risk behaviors among injection drug users.

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