The link between the use of crack cocaine and the sexually transmitted diseases of a clinic population - A comparison of adolescents with adults

Background and Objectives: To determine whether personal and/or a partner's use of crack cocaine is associated with the diagnosis of early syphilis or gonorrhea independent of high-risk sex behaviors, and to determine whether the relationships between crack cocaine and associated sexually transmitted diseases (STDs) are similar for adolescents and adults. Study Design: A cross-sectional behavioral survey of heterosexual males and females attending public STD clinics in three cities. Logistic regression was used to identify risk behavior patterns associated with each STD compared with no STD. Results: Multivariate analysis revealed that men who were high on drugs, including crack cocaine, before or during sex were more likely to be diagnosed with syphilis (Odds Ratio [OR] = 1.49; Confidence Intervals [CI] = 1.06, 2.13). Males more likely to be diagnosed with gonorrhea were younger (OR = 0.94; CI = 0.92, 0.96), had sex with a crack cocaine user (OR = 1.99; CI = 1.36, 2.91), did not use condoms last time they had sex with a nonmain partner (OR = 1.59; CI = 1.09, 2.13), and did not have sex with an intravenous drug user (OR = 0.45; CI = 0.22, 0.95). For women, there were no independent risk factor for syphilis but younger age was a risk factor for gonorrhea (OR = 0.95; CI = 0.91, 0.99). The associations between crack cocaine and syphilis and gonorrhea in men and between crack cocaine and syphilis in women were not significant among adolescents in this study. Conclusion: The results of this study highlight the differences in the crack cocaine-related behaviors of adults and adolescents at risk for gonorrhea and syphilis. The nature of these differences support the use of distinct intervention strategies for each STD and for adolescents and adults.