As for homosexual practices, aside from their lack of novelty, there are two particular features that show up in the literature. It is male relationships rather than female that tend to be promiscuous (lesbians generally pair off in what amounts to marriage without legal sanction, and tend to maintain stable relationships; but men usually do not); accordingly, it is the male rather than the female homosexual who is significant in the VD problem. Secondly, the male relationship generally involves pederasty, so that the lesions and symptoms in the passive member of the pair are usually found in the rectum, where they may show some of the diagnostic difficulties otherwise peculiar to women. This applies more to the painless primary sore of syphilis than to gonorrhea, which is more likely to be painful in men whether is be urethral or rectal, and so draws the patient's attention to it.

Basically, then, this part of the VD problem comes down to the two elements, promiscuity and the forces that encourage or sustain it, which in turn fall into the two groups, professional and amateur, or free enterprise and just free. Willcox, in his review of prostitution and VD, in the 1958 UN Report, put the point this way:

“In a prosperous economy, the bulk of women work and provide for themselves, living alone if necessary. Many, if not the majority, have sexual intercourse before marriage, some with a number of men. The more promiscuous no longer require money for rent and food but still crave for luxuries which their wage cannot provide from men who are attracted to them by the possibility of sexual intercourse. Many girls, too, are promiscuous because they like to be, although few writers say so. Thus the demand for prostitution decreases. The prostitute now has a competitor and she ceases to be the major factor in the spread of venereal disease. Such is the state of affairs in Canada, the United States and, to a varying degree, in a number of countries of western Europe today.”

As late as 1961 a paper from Finland cited the general opinion voiced in Sweden and the United States that the significance of prostitution in the spread of VD had declined. There was the suggestion that this might not have been true for seaport towns. But even so there is reason to believe that what had been happening in those years was not so much a decrease of prostitution as a change in its form, with a diminution or disappearance of the old traditional whorehouses and red light districts, and an emergence of one or more different types of organized operation.

An example relates to New York City, where the Health Department, on June 30, 1967, closed its Criminal Court clinic, where accused prostitutes had been examined and treated for VD, substituting a pledge that they submit to examination within forty eight hours either by a private doctor or at a public VD clinic. This action was taken in the belief that prostitutes bad become less important than formerly in spreading YD. Then, in September of the same year, a law calling for up to one year in jail for convicted streetwalkers was "liberalized"; the maximum penalty became fifteen days in jail and a fine of $250. It had been argued that the longer jail term had not been effective, and that prostitution, in any event, was a "social" rather than a "criminal" problem. It then appeared that the lenient new law encouraged and in effect caused the proliferation of a variant of the old practice. Pimps, each with a coterie of whores, began to infest New York's midtown area of theaters, restaurants, flashy shops, and hotels; the girls solicited in traditional fashion and used the hotels as their base of operations; the pimps took care of the legal side of the transaction and pocketed most of the take. Judges and police had no doubt that the lenient law was the cause of the increased activity, forgetting that the harsher earlier law had been admittedly ineffectual. (see SPECIFIC SOCIAL FACTORS IN THE VD PROBLEM PART V)