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From 1947 to 1957, the syphilis death rate fell by 75 percent and the syphilis incidence rate fell by 95 percent.
"That's a huge drop in syphilis. It's essentially a collapse," Francis said.
In order to test his theory that risky sex increased as the cost of syphilis dropped, Francis analyzed data from the 1930s through the 1970s from state and federal health agencies. Some of the data was only available on paper documents, but the Centers for Disease Control and Prevention (CDC) digitized it at the request of Francis.
For his study, Francis chose three measures of sexual behaviour: The illegitimate birth ratio; the teen birth share; and the incidence of gonorrhea, a highly contagious sexually transmitted disease that tends to spread quickly.
"As soon as syphilis bottoms out, in the mid- to late-1950s, you start to see dramatic increases in all three measures of risky sexual behaviour," Francis said.
While many factors likely continued to fuel the sexual revolution during the 1960s and 1970s, Francis says the 1950s and the role of penicillin have been largely overlooked.
"The 1950s are associated with prudish, more traditional sexual behaviours," he said.
"That may have been true for many adults, but not necessarily for young adults. It's important to recognize how reducing the fear of syphilis affected sexual behaviours," he said.
A few physicians sounded moralistic warnings during the 1950s about the potential for penicillin to affect behaviour. Spanish physician Eduardo Martinez Alonso referenced Romans 6:23, and the notion that God uses diseases to punish people, when he wrote:
"The wages of sin are now negligible. One can almost sin with impunity, since the sting of sinning has been removed," he said.
Such moralistic approaches, equating disease with sin, are counterproductive, Francis says, stressing that interventions need to focus on how individuals may respond to the cost of disease.