Why calling monkeypox an STD is about more than just a label
“I don’t think we have enough information at this point to completely classify it. I think there’s some suggestions, but there’s more study that needs to be done,” Adalja said.
“There are other infections — for example, syphilis — that spread through other ways other than sexual transmission,” he said. “Zika virus is a mosquito-borne illness, but it can also be spread sexually. The question to me is more about making sure we’re clear on what’s going on from a physiological standpoint before you would make that type of claim.”
Some experts argue that labeling monkeypox as an STD could be not only misleading but potentially harmful for public health.
“A negative about suggesting that monkeypox is an STD is that people who are not having sex think immediately, ‘OK, I’m not going to get it,’ ” said Dr. Saju Mathew, an Atlanta-based primary care physician and public health specialist.
“What a lot of people will think is it’s like herpes or gonorrhea or chlamydia — meaning you have to have sex to get it. That’s not true. So that is why it’s dangerous to suggest that it is only exclusively transmitted via sex. That’s misinformation,” he said. “It is transmitted via sex in a majority of cases, but it’s not exclusively transmitted via intimate contact. You can also get it through non-intimate contact.”
David Harvey, executive director of the National Coalition of STD Directors, said he and his colleagues refer to monkeypox as a “sexually associated” infection for now.
“With the data that is available now, we know that the primary mode of transmission is sexually associated — contact that is of a sexual nature. Technically, a sexually transmitted infection is defined as an exchange of genital fluid that have a virus or bacteria that is associated with a sexually transmitted infection,” Harvey said. “We need the science that shows definitively that this is an infection that can be passed by semen or genital fluids, and the science on that is not quite clear yet, which is why we’re calling this sexually associated.”
What makes an STD
STDs, also known as sexually transmitted infections or STIs, are infections that are passed from one person to another through sexual contact such as vaginal, oral or anal sex. In some cases, these infections also can spread through skin-to-skin intimate contact, as with herpes and HPV.
The long history of STDs dates to archaic times. Some studies suggest that migrations of modern human ancestors can be associated with HPV, types of herpes and other sexually transmitted diseases.
In modern times, a study out of Nigeria was among the first recent reports to describe the possible sexual transmission of monkeypox. That country experienced a large outbreak of monkeypox in humans in September 2017, and the study about it was published in the journal PLOS One in 2019. Previously, human-to-human transmission was thought to primarily occur by means of saliva or respiratory droplets or direct contact with the pus or crust of lesions.
“There is no formal process to label an infection as an STI or STD,” Kristen Nordlund, a spokesperson for the US Centers for Disease Control and Prevention, wrote in an email to CNN on Monday. “Experts generally determine, scientifically, if a pathogen can be transmitted through sex, in which case it’s called ‘sexually transmissible.’ And how frequently the infection is referred to as an STI relates to the proportion of transmissions accounted for by sex vs some other route — but there is no ‘rubric’ that is used to guide this determination.”
She said monkeypox can be described more accurately as “sexually transmissible,” as sex is one of the ways the virus can spread — but not the only way.
“Sex is a human behavior. If stigma wasn’t associated with infections transmitted through sex, there would be less concern of implications for saying monkeypox is an STI for people who are more heavily impacted,” Nordlund wrote. “It’s also important to look at this question globally — and keep in mind the implications for this label vary depending on where you are in the world. For example, there are countries where homosexuality is penalized by prison or even death. Labeling monkeypox as a STI or STD could have far-reaching consequences in these countries.”
The monkeypox virus can spread during skin-to-skin contact, direct contact with a monkeypox rash or scabs from an infected person, or direct contact with their respiratory secretions. Scientists are still researching whether monkeypox can be spread through semen or vaginal fluids.
Although the risk is low, there is also some potential for the virus to spread through items or surfaces like clothing, bedding or towels that were used by someone with monkeypox.
Mathew said the skin lesions caused by a monkeypox infection actually could be mistaken for a common STD like herpes or syphilis, and in some cases, a person with monkeypox could have coinfections with common sexually transmitted diseases.
When he treated his first…
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