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Why Calling Monkeypox An STD Is More Than Just A Label

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A feature of the ongoing monkeypox epidemic is that most cases are sexually linked, causing some debate as to whether the disease should be described as a sexually transmitted disease.

“Many infectious diseases fall into a single route of transmission, but have multiple transmission mechanisms,” said Dr. Amesh Adalja. Johns Hopkins Center for Health Security at the Johns Hopkins Bloomberg School of Public Health. Monkeypox can be transmitted sexually, but it is also clearly transmitted through close non-sexual contact.

“At the moment, I don’t think there is enough information to fully classify it. I think I have some suggestions, but more research needs to be done,” Adalja said.

“There are other infections that are spread other than sexually, such as syphilis,” he said. “The Zika virus is a mosquito-borne disease, but it is also transmitted through sexual contact. is to do.”

Some experts argue that classifying monkeypox as a sexually transmitted disease is not only misleading, but potentially harmful to public health.

“The downside of suggesting that monkeypox is a sexually transmitted disease is that people who don’t have sex immediately think, ‘OK, I’m not going to get it,'” he said. said Dr. Saju Mathew, an Atlanta-based primary care physician and public health specialist.

“Many people think it’s like herpes, gonorrhea or chlamydia, which means you have to have sex to get it. It’s dangerous to do. It’s misinformation,” he said. “Most of the time, it’s transmitted through sexual contact, but not just through intimate contact. It can also be transmitted through non-intimate contact.”

David Harvey, executive director of the National Coalition of STD Directors, said he and his colleagues for now refer to monkeypox as a “sexually-related” infection.

“Currently available data show that the primary mode of transmission is sexual relations, i.e., contact of a sexual nature. “It’s defined as the exchange of genital fluid with bacteria,” Harvey said. is not yet clear, which is why we call it sexually relevant.”

STDs, also known as sexually transmitted infections or STIs, are infections that are passed from person to person through sexual contact, such as vaginal, oral or anal intercourse. In some cases, these infections can also be spread through close skin-to-skin contact, like herpes or his HPV.

The long history of STDs goes back to quaint times. Some studies suggest that the ancestral migration of modern humans HPV, types of herpes and other sexually transmitted diseases.

In modern times, a study from Nigeria was one of the first recent reports to describe the sexually transmitted potential of monkeypox. In that country he had an outbreak of monkeypox in humans in September 2017, and a study was conducted on it. Published in the journal PLOS One in 2019. Previously, human-to-human transmission So I thought occur mainly By direct contact with saliva or respiratory droplets or lesion pus or crusts.

“There is no formal process for classifying infectious diseases as sexually transmitted or STDs,” Kristen Nordland, a spokesperson for the U.S. Centers for Disease Control and Prevention, wrote in an email to CNN on Monday. “Experts generally scientifically determine whether a pathogen can be transmitted through sexual contact. In that case, it is called ‘sexually transmitted.’ Also, the frequency with which an infection is referred to as a sexually transmitted disease is related to the proportion of transmission by sex versus transmission by other routes, but there is no “rubric”. used to guide this decision. ”

She said monkeypox could be more accurately described as a “sexually transmitted disease.” Because sex is one way the virus spreads, but not the only way.

“Sex is a human act. If stigma was not associated with sexually transmitted diseases, there would be less concern associated with saying that monkeypox is a sexually transmitted disease in people with more serious consequences.” It’s also important to look at the problem globally, remember that the meaning of this label varies depending on where you are in the world. Classifying it as an infectious or sexually transmitted disease could have far-reaching consequences in these countries.”

The monkeypox virus can be spread by skin-to-skin contact, direct contact with the monkeypox rash or scabs of an infected person, or direct contact with respiratory secretions. Scientists are still studying whether monkeypox spreads through semen or vaginal fluids.

The risk is low, but the potential is there as well. The virus is spread through clothing, bedding, towels, and other items and surfaces used by monkeypox patients.

Mathew says that skin lesions caused by monkeypox infection can actually be mistaken for common STDs such as herpes or syphilis, and in some cases monkeypox patients overlap with common sexually transmitted diseases. Said it could be infected.

When treating the first monkeypox patient in Atlanta, Matthew immediately noticed the typical lesions on his face. But the 25-year-old man also had hip pain, Matthew said. “He ended up with another sexually transmitted disease in addition to monkeypox,” which was herpes.

Mathew added that about 25% of monkeypox patients in the United States are co-infected with STDs.

“When diagnosing monkeypox, you need to test for monkeypox, but you also need to do various other STI tests to make sure they are ruled out or diagnosed,” Harvey said. There is.”

“We happen to have the highest rate of sexually transmitted infections in American history, so it’s not surprising that more STIs are being diagnosed in connection with the current monkeypox outbreak. ‘ he said. “Anecdotally, we’re hearing from several clinics around the country that his co-infection rates with other sexually transmitted infections range from 15% to 40%, but there’s no national data on that at this time. .”

CDC’s clinical guidance tells health care providers: However, co-infections of monkeypox and sexually transmitted diseases have been reported, and the presence of a sexually transmitted disease does not exclude monkeypox. ”

Attempts to call monkeypox a sexually transmitted disease “only add to the stigma and ignore other means of transmission,” says Jason, a nursing scientist and first Leadership and Innovation Endowment Chair. Furley said. Johns Hopkins University School of Nursingwrote in an email to CNN.

“The virus is spreading among close contacts and sexual networks within gay, bisexual, and other male communities who have sex with men. In the latter, transmission is more likely through skin-to-skin contact between parent and child, but environmental contamination that leads to infection is also possible,” says Farley. I am writing.

“If you look at how the response to AIDS, for example, has played out, it took the heterosexual community almost a decade to pay attention and realize that HIV is not a gay disease,” he says. is writing “We cannot allow the same form of inaccurate information to guide public health today.”

Harvey of the National Coalition of STD Directors said stigma is something STD clinics fight every day and he’s worried about. On the stigma attached to monkeypox outbreaks in the context of being a sex-related disease.

“I don’t want people to dismiss this as a sexually transmitted disease, but on some level, this comes with embracing the stigma of a sexually transmitted disease,” he said. , for those of us who deal with these issues every day, we want to do everything we can to break down the stigma especially associated with sexually transmitted infections, so that people can get tested without feeling shame or fear. , so that they can receive treatment.”

Overall, whether monkeypox is designated an STD or not, Harvey said the response to the outbreak has put STD clinics under pressure.

“STIs and sexual health clinics across the country are currently under the brunt of meeting testing and treatment needs and do not have the additional funding to handle the influx of patients. We are already seeing testing and care for other STDs suspended,” Harvey said.

1 Survey of 80+ clinicsconducted by the National Coalition of STD Directors between July 26 and 29, 63% had a referral from another provider with suspected monkeypox and 52% had a referral from another provider. 40% had monkeypox reactions, resulting in unexpected costs in supplies and personnel.

Also, 65% of clinics needed to change workflows to manage monkeypox, such as moving from walk-in clinics to appointments only, and 22% said they needed to change other STIs to prioritize monkeypox services. There was a need to reduce symptomatic or asymptomatic screening.

“There is a lack of additional funding or federal funding that could directly support these programs,” Harvey said. Said. “These programs require supplies, testing, testing cost support, and additional staff time and other types of capacity to support the response to this outbreak.”

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