Recent changes in the epidemiology of genital ulcer disease in the United States. The crack cocaine connection.

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)