{"id":801,"date":"2013-03-26T12:00:13","date_gmt":"2013-03-26T12:00:13","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=801"},"modified":"2013-03-28T10:20:03","modified_gmt":"2013-03-28T10:20:03","slug":"was-the-sexual-revolution-triggered-by-the-decline-of-syphilis","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2013\/03\/26\/was-the-sexual-revolution-triggered-by-the-decline-of-syphilis\/","title":{"rendered":"Was the \u201csexual revolution\u201d triggered by the decline of syphilis?"},"content":{"rendered":"<p>The year 1939 saw total US syphilis deaths at <b>15<\/b> per 100,000 and syphilis deaths of black males at <b>72.5<\/b> per 100,000: this is a death rate comparable to that for HIV\/AIDS at the height of the epidemic in 1995 when total deaths and deaths of black males stood, respectively, at <b>16.2<\/b> and <b>80.2<\/b> per 100,000.\u00a0 Subsequently, in the late 40s and early 50s, incidence and mortality from syphilis were to fall precipitously \u2013 thanks to penicillin.\u00a0 A recent paper in the <i>Archives for Sexual Behavior<\/i> by an economist, Andrew Francis, argues for the importance of this collapse in the \u201ccost\u201d of syphilis in spurring the sexual revolution (<a href=\"http:\/\/link.springer.com\/article\/10.1007%2Fs10508-012-0018-4\">http:\/\/link.springer.com\/article\/10.1007%2Fs10508-012-0018-4<\/a>). His exploration of this hypothesis prompts general reflection on the link between the \u201ccost\u201d of disease (which he equates with absence of an effective treatment) and sexual behaviour.<\/p>\n<p>The paper correlates data across US states on syphilis incidence and mortality with measures of \u201crisky non-traditional sex\u201d \u2013 which, in the context of the poverty of relevant data for the period, is evaluated on the basis of gonorrhoea rate, illegitimate birth ratio and teen birth share.\u00a0 Coefficients are given from regressions of measures of sexual behaviour on indicators for the number of years since syphilis collapse (which varies by state).\u00a0 As regards illegitimate birth ratio and teen birth share, a positive correlation emerges which goes back as early as three years or less from syphilis collapse; gonorrhoea, however, continues to decline from its WW2 peak, as we might expect.<\/p>\n<p>Ultimately, however, Francis\u2019s argument rests also on the claim that his own explanation of sexual revolution fits the facts better than the alternative explanations, of which the most familiar is that \u201canti-conception technology\u201d, especially the pill, played a decisive role. \u00a0Francis admits that, from the late sixties, conception technologies and measures of risky behaviour increase simultaneously.\u00a0 Yet measures of risky sexual behaviour, he claims, had already been rising sharply for a decade before anti-conception technology began to make its impact.\u00a0 His own data show that the two changes do not coincide.\u00a0 \u00a0Nor do measures of permissive values or religious observance show any discontinuous change that would coincide with the increase in risky behaviour.\u00a0 So if Francis\u2019 hypothesis is wrong, then the precise timing of the sexually revolution remains mysterious.\u00a0 Francis gestures vaguely towards the possibility of the change in sexual behaviour being triggered by still less definable \u201ceconomic, social and cultural changes\u201d.<\/p>\n<p>The obvious recent parallel to the syphilis collapse in our own times would be impact of the introduction of HAART on HIV\/AIDS mortality.\u00a0 The concern that an effective therapy might lead to disinhibition has been widely discussed in STI journal and elsewhere.\u00a0 An increase in risk-taking behaviour among MSM during the late 1990s has been established:\u00a0 <a href=\"http:\/\/sti.bmj.com\/content\/77\/3\/184.abstract?sid=5d909365-4627-4232-8ef4-a93445f5baed\">http:\/\/sti.bmj.com\/content\/77\/3\/184.abstract?sid=5d909365-4627-4232-8ef4-a93445f5baed<\/a> (Stolte &amp; Coutinho: Amsterdam);\u00a0 <a href=\"http:\/\/sti.bmj.com\/content\/80\/6\/451.abstract?sid=5d909365-4627-4232-8ef4-a93445f5baed\">http:\/\/sti.bmj.com\/content\/80\/6\/451.abstract?sid=5d909365-4627-4232-8ef4-a93445f5baed<\/a> (Elford &amp; Hart: London); <a href=\"http:\/\/sti.bmj.com\/content\/80\/6\/518.abstract?sid=5d909365-4627-4232-8ef4-a93445f5baed\">http:\/\/sti.bmj.com\/content\/80\/6\/518.abstract?sid=5d909365-4627-4232-8ef4-a93445f5baed<\/a>(Cox &amp; Allard: Montreal); <a href=\"http:\/\/sti.bmj.com\/content\/79\/1\/7.abstract?sid=5d909365-4627-4232-8ef4-a93445f5baed\">http:\/\/sti.bmj.com\/content\/79\/1\/7.abstract?sid=5d909365-4627-4232-8ef4-a93445f5baed<\/a> (Stephensen &amp; Williams: London).\u00a0 But opinions on the contribution of HAART to changing sexual behaviour seem divided, with Stolte &amp; Coutinho supporting the hypothesis, and the others inclined to attribute it to other factors.\u00a0 The probable future emergence of multi-resistant gonorrhoea (<a href=\"http:\/\/sti.bmj.com\/content\/87\/Suppl_2\/ii39\">http:\/\/sti.bmj.com\/content\/87\/Suppl_2\/ii39<\/a>) represents the inverse case (loss of a therapy leading to potential inhibition).\u00a0 If the diminished \u201ccost\u201d of an STI (syphilis) can spur an increase in risky sexual behaviour, should we not expect an increased cost to have the opposite result? \u00a0Time will tell.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The year 1939 saw total US syphilis deaths at 15 per 100,000 and syphilis deaths of black males at 72.5 per 100,000: this is a death rate comparable to that for HIV\/AIDS at the height of the epidemic in 1995 when total deaths and deaths of black males stood, respectively, at 16.2 and 80.2 per [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2013\/03\/26\/was-the-sexual-revolution-triggered-by-the-decline-of-syphilis\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2043,2783,2381],"tags":[],"class_list":["post-801","post","type-post","status-publish","format-standard","hentry","category-behaviour","category-historical","category-syphilis"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Was the \u201csexual revolution\u201d triggered by the decline of syphilis? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2013\/03\/26\/was-the-sexual-revolution-triggered-by-the-decline-of-syphilis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Was the \u201csexual revolution\u201d triggered by the decline of syphilis? - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"The year 1939 saw total US syphilis deaths at 15 per 100,000 and syphilis deaths of black males at 72.5 per 100,000: this is a death rate comparable to that for HIV\/AIDS at the height of the epidemic in 1995 when total deaths and deaths of black males stood, respectively, at 16.2 and 80.2 per [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2013\/03\/26\/was-the-sexual-revolution-triggered-by-the-decline-of-syphilis\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2013-03-26T12:00:13+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2013-03-28T10:20:03+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/03\\\/26\\\/was-the-sexual-revolution-triggered-by-the-decline-of-syphilis\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/03\\\/26\\\/was-the-sexual-revolution-triggered-by-the-decline-of-syphilis\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Was the \u201csexual revolution\u201d triggered by the decline of syphilis?\",\"datePublished\":\"2013-03-26T12:00:13+00:00\",\"dateModified\":\"2013-03-28T10:20:03+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/03\\\/26\\\/was-the-sexual-revolution-triggered-by-the-decline-of-syphilis\\\/\"},\"wordCount\":628,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"articleSection\":[\"Behaviour\",\"Historical\",\"Syphilis\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/03\\\/26\\\/was-the-sexual-revolution-triggered-by-the-decline-of-syphilis\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/03\\\/26\\\/was-the-sexual-revolution-triggered-by-the-decline-of-syphilis\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/03\\\/26\\\/was-the-sexual-revolution-triggered-by-the-decline-of-syphilis\\\/\",\"name\":\"Was the \u201csexual revolution\u201d triggered by the decline of syphilis? 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