As the global threat of mpox persists, with cases emerging in countries outside of Africa, the scientific community is grappling with how to classify and address this virus. The debate centers on whether mpox should be labeled as a sexually transmitted disease (STD) to facilitate targeted public health interventions.
The World Health Organization (WHO) first declared mpox a global health emergency in 2022, targeting the clade 2b strain prevalent in Africa. Although this strain is still present, it has spread at lower levels. In late 2024, a newer and more potent variant, clade 1b, has been widespread in Central Africa, and cases have also spread through travel to Europe, Asia, and North America.
Arguments For Labeling Mpox as an STD
During the 2022 outbreak, 98% of mpox cases were transmitted sexually, predominantly affecting bisexual individuals and men who have sex with men (MSM). In late 2022, a commentary in the journal Clinical Infectious Diseases argued that mpox’s transmission dynamics align with those of an STD. The authors suggested that labeling mpox as an STD would enhance public health interventions, including vaccinations, testing, and treatment, and promote focused awareness and behavioral changes to reduce exposure.
These arguments were grounded in the Bradford Hill criteria, which provide a framework for establishing causal relationships in epidemiology. By meeting these criteria, advocates for labeling mpox as an STD aimed to justify targeted public health measures specifically addressing sexual transmission routes.
Arguments Against Labeling Mpox as an STD
However, critics argue that mpox transmission dynamics differ between historical outbreaks in Africa and recent incidents. Historical outbreaks, largely localized, were primarily driven by household contact or animal-to-human transmission via bushmeat, with limited evidence of sexual transmission. Aniruddha Hazra and Joseph N Cherabie, in the same issue of Clinical Infectious Diseases, warned that labeling mpox as an STD could divert attention from vulnerable groups, including pediatric cases.
Kerala, which reported the first case of clade 1b early last year, has seen minimal mpox spread, with successful treatment and no secondary infections. Public health experts, including T.S. Anish, Anaswara Naveen, and Reghukumar Aravind, advocated in The Lancet that labeling mpox as an STD could undermine global containment efforts. They emphasized the psychological and social impact of stigma on affected communities and individuals, particularly MSM, arguing that stigma could deter people from seeking treatment.
Dr. Aravind highlighted the current context in Kerala: “People trust the healthcare system and are willing to report mild lesions and undergo isolation. Labeling mpox as an STD could push patients underground, leading to potential human-to-human transmission.”
Indian Perspectives on Mpox as an STD
The Indian context adds another layer to the debate. Kerala’s experience in treating mpox without major outbreaks demonstrates that the virus, while present, is not the catastrophic threat it is in some other regions. Kerala Health Department officials stress the importance of tailored public health strategies that consider the social and psychological impact of labeling mpox as an STD.
Health officials in Kerala noted that most mpox patients in the 2022 outbreak were expatriates working in the Middle East. They worry that labeling mpox as an STD could erode trust, leading patients to avoid seeking care. Dr. Aravind further emphasized that, unlike HIV, mpox is rarely fatal, and people might wait out the infection rather than seek medical attention, posing a risk of further spread.
An official from the Kerala Health Department stated, “Our information, education, and communication (IEC) strategies are carefully crafted to avoid fueling stigma and to ensure effective treatment and containment. Quantifying mpox as an STD could inadvertently result in marital breakdowns and other societal issues.”
The Union Health Ministry’s assessment team in Kerala also refrained from focusing on sexual transmission, prioritizing treatment and containment over interrogation of the patients’ behavior.
Conclusion: Balancing Science and Social Impact
The debate over labeling mpox as an STD underscores the complexity of public health strategies. While scientific facts are crucial, they must be balanced with the social and psychological well-being of affected communities. Kerala’s approach illustrates the need for context-specific interventions that prioritize trust and non-stigmatizing communication.
As the global health community continues to navigate the mpox outbreak, a nuanced and empathetic approach is essential. Public health measures should not only aim to contain the virus but also to protect the mental health and social fabric of communities.
We encourage readers to share their thoughts and experiences on this critical issue. Join the conversation and help shape informed public health policies.
Published – February 12, 2025 12:10 pm IST
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The post Is Mpox an STD: Debate Heating Up in Public Health Circles appeared first on Archynetys.