Sex, Methamphetamine, and a Surge in Syphilis Among Women and Men Who Have Sex With Women: A Call to Diversify Research Addressing Sexualized Drug Use

Globally rates of syphilis have been increasing since 1990 and, historically transmission has predominated among gay, bisexual, and men who have sex with men (GBMSM). In the past decade, transmission has increased among women and men who have sex with women (MSW). This led Australia to declare syphilis a communicable disease of national significance in August 2025. In this commentary, we consider the implications of these developments on conceptions of sexualized drug use (SDU) and research in this field. To date, discourses surrounding SDU have often focused on GBMSM and the culturally specific practice of chemsex. Yet emerging data outlining an association between methamphetamine use and syphilis transmission across populations may warrant a more inclusive SDU research agenda. In reflecting on this topic, we acknowledge that while the association between methamphetamine use and syphilis transmission may stimulate additional research on SDU, there are drawbacks associated with this research focusing on sexually transmitted infections (STIs) alone. We look to the literature on GBMSM and chemsex as a blueprint for a potential research agenda on SDU as practiced by women and MSW. Chemsex research was initially spurred by concerns regarding HIV transmission, however, this body of work has expanded over time to traverse domains of health and wellbeing, service delivery, evaluation and critical theory. We suggest that a similarly diverse body of empirical, applied and critical research on SDU is required to shape culturally appropriate, interdisciplinary services that meet the varied information and support needs of women and MSW who use drugs in sexual contexts.