“There are other infections — syphilis, for example — that are spread in ways other than sexual transmission,” he said. “Zika is a mosquito-borne disease, but it can also be sexually transmitted. The question for me is more about making sure we’re clear about what’s going on physiologically before you make those kinds of claims.” Some experts argue that labeling monkeypox as an STD could be not only misleading but also potentially harmful to public health. “One downside to suggesting that monkeypox is an STD is that people who don’t have sex immediately think, ‘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 that it’s like herpes or gonorrhea or chlamydia — meaning you have to have sex to get it. That’s not true. That’s why it’s dangerous to suggest that it’s transmitted exclusively through sex. This it’s misinformation,” he said. “Most of the time it’s transmitted through sex, but it’s not exclusively transmitted through 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 transmitted” infection for now. “With the data available now, we know that the main mode of transmission is sexual — contact that is sexual in nature. Technically, a sexually transmitted infection is defined as an exchange of genital fluids that have a virus or bacteria associated with a sexually transmitted infection,” Harvey said. “We need the science to definitively show that this is an infection that can be transmitted through semen or genital fluids, and the science on that is still not clear enough, so we’re calling it sexually transmitted.”
What does an STD do?
STDs, also known as sexually transmitted infections or STDs, 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 can also be spread through close skin-to-skin contact, such as with herpes and HPV. The long history of STDs dates back to archaic times. Some studies suggest that the migrations of modern human ancestors may be associated with HPV, types of herpes and other sexually transmitted diseases. In modern times, a study from 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 occur mainly through saliva or respiratory droplets, or direct contact with the pus or crust of the lesions. “There is no formal process for labeling an infection as an STD or STD,” Kristen Nordlund, a spokeswoman for the US Centers for Disease Control and Prevention, wrote in an email to CNN on Monday. “Experts generally determine, scientifically, whether a pathogen can be transmitted through sex, so it’s called ‘sexually transmitted.’ And how often the infection is reported as an STD is related to the ratio of transmission through sex versus some other route — but there is no ‘rubric’ used to guide that determination.” He said monkeypox might be more accurately described as “sexually transmitted,” since sex is one way the virus is transmitted — but not the only way. “Sex is a human behavior. If the stigma wasn’t associated with sexually transmitted infections, there would be less concern about monkeypox being an STD for people who are most affected,” Nordlund wrote. “It’s also important to look at this question globally — and keep in mind that the consequences for this label vary depending on where you are in the world. For example, there are countries where homosexuality is punishable by imprisonment or even death. Labeling monkeypox as an STD or STD could have far-reaching consequences in these countries.” Monkeypox virus can be spread by skin-to-skin contact, direct contact with a rash or scab from an infected person, or direct contact with their respiratory secretions. Scientists are still investigating whether monkeypox can be transmitted through semen or vaginal fluids. Although the risk is low, there is also some chance that the virus can spread through items or surfaces such as clothing, bedding or towels that have been used by a person with monkeypox. Matthew said skin lesions caused by a monkeypox infection could actually be mistaken for a common STD, such as herpes or syphilis, and in some cases, a person with monkeypox may have co-infections. with common sexually transmitted diseases. When he treated his first monkeypox patient in Atlanta, Matthew immediately noticed that the person had the typical lesions on his face. But the 25-year-old man also had pain in his buttocks, Matthew said. “He ended up having another STD besides monkey pox,” which was herpes. Mathew added that about 25% of monkeypox patients in the US had STD co-infections. Harvey said that “when diagnosing monkeypox, you have to test for monkeypox, but you also have to do a number of other STD tests to make sure those are either ruled out or diagnosed as well.” “We happen to have the highest rates of sexually transmitted infections in the US, basically in American history. So it’s no surprise that we’re diagnosing more STDs in the context of the current monkeypox outbreak,” he said. “Anecdotally, we’re hearing from some of our clinics around the country that they’re seeing rates of 15% to 40% of co-infections with other STIs, but we don’t have national data on that right now.” CDC clinical guidance tells health care providers: “It is important to thoroughly evaluate patients presenting with genital or peranal ulcers for STDs. However, co-infections with monkeypox and STDs have been reported, and the presence of an STD does not exclude monkey pox.”
Fighting stigma
Any efforts to label monkeypox as a sexually transmitted infection “will only increase the stigma and ignore other means of transmission,” Jason Farley, a nurse scientist and the inaugural Leadership and Innovation Endowed Chair at the School of Nursing, wrote in an email to CNN. of Johns Hopkins University. . “The virus spreads among intimate contacts and sexual networks in the gay, bisexual and other men who have sex with men communities. We have also seen spread, albeit limited so far, in households with cases in men, women and children. The latter are likely to be transmitted through skin-to-skin contact between parents and children, but environmental contamination leading to transmission is also possible,” Farley wrote. “If we look at how the response to AIDS, for example, has evolved, it took almost a decade for the heterosexual community to pay attention and realize that HIV was not a gay disease,” he wrote. “We cannot allow the same form of inaccurate information to guide our public health practice today.” Harvey, of the National Coalition of STD Directors, said stigma is something STD clinics battle every day, and he’s concerned about the monkeypox outbreak being stigmatized as a sexually transmitted disease. “We don’t want people to dismiss this as a sexually transmitted infection, but on some level, this de-stigmatizes sexually transmitted infections,” he said. “And so, for those of us who work in this field on a full-time basis and deal with these issues day in and day out, we want to do everything we can to break the stigma, especially around STDs. so that we can ensure that people are tested and treated without shame or fear.” Overall, whether monkeypox is classified as an STD or not, Harvey said the response to the outbreak is putting a strain on STD clinics. “STD and sexual health clinics across the country are burdened with responding to testing and treatment needs right now — and they don’t have additional funding to handle the influx of patients. We’re also seeing more testing for sexually transmitted infections and care has already disrupted,” Harvey said. A survey of more than 80 clinics, conducted by the National Coalition of STD Directors, between July 26 and 29 found that 63% have received referrals from other health care providers for suspected smallpox cases, 52% have served people removed from other providers and 40% have incurred unforeseen costs for supplies or personnel due to the monkeypox response. Also, 65% of clinics had to modify workflows to manage monkeypox, such as changing from walk-in to an appointment-only clinic, and 22% had to reduce either symptomatic or asymptomatic screening for other STIs for to prioritize monkeypox services. There is “a lack of additional funding, a lack of federal funding, that can directly support these programs,” Harvey said. “These programs need support for supplies, testing, to pay for testing, they need additional staff hours and other types of capacity to help support the response to this outbreak.”
