Syphilitic Reflections on the 20th Century

At times, working on a long-term STI research project, it is easy to become embroiled in the minutiae of the day-to-day. When times like this strike, it is crucial to remember the bigger picture. From a less cosmic perspective, some historical appreciation of our place in sexual health is often required, both as a reflection on how much has been achieved and a reminder of the forces that continue to influence this work.

Above is a graph to which I turn when such a reminder is necessary – it depicts syphilis diagnoses in genitourinary medicine clinics in the UK from 1931–2004. A favorite of epidemiologists working in sexual health, this graph appeared in lectures in various subjects throughout my studies; it was used as a tool to prompt students to consider transmission dynamics of STIs and the many factors that influence these. As a student, a graphic representation of the holistic, interdisciplinary principles that first drew me to a career in public health was a delight to my highly visual brain.

To me, the beauty of this graph is that it illustrates, in a quick glance, the sheer variety of elements that influenced sexual behavior and STI transmission throughout the 20th century, and continue to do so today. These include conflict (World War II and the associated migration, displacement and return), new infections and new responses (the advent of HIV/AIDS in the early ‘80s and subsequent health promotion campaigns and fear promotion campaigns), scientific advances (the advent of penicillin in the 1940s; the development of an effective HIV treatment regime in the ‘90s), and social attitudes (the sexual revolution of the ‘60s and ‘70s; the complacency that arose once HIV treatment transformed a death sentence into a manageable condition).

Although these data are specific to a particular disease, time and place, the principles apply to a wide array of examples throughout history and today. For those of us with a passion for sexuality, infectious diseases or public health more broadly, none of this information is new; it is likely that the fascinating complexity of human behavior and health outcomes is what brought us to this line of work in the first place. However, it is rare to see such complexity expressed in a visually straightforward way. Or perhaps this is merely my way of justifying geeking out over a syphilis graph.

On long days filled with the ennui of urine samples and vaginal swabs, demanding stakeholders and lengthy reports, when questionnaire data seems endless and kudos in short supply, I must reflect on the reasons why I do the work that I do. The complexity is challenging but it underscores the importance of responsive, interdisciplinary research and education in sexuality and sexual health. Sometimes a little syphilis is the best reminder.

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