In 2022, a global mpox outbreak sparked urgent conversations about how the virus spreads—and whether it should be classified as a sexually transmitted disease (STD). Formerly known as monkeypox, mpox grabbed headlines as cases surged in over 100 countries, primarily among men who have sex with men (MSM). But while sexual contact played a key role in transmission, experts disagree on labeling it an STD. The debate isn’t just about semantics—it has real-world implications for public health strategies, stigma, and prevention. Let’s unpack the science, the arguments, and why this discussion matters.
How Does Mpox Spread? Breaking Down Transmission
Mpox is a viral illness caused by the Orthopoxvirus family, related to smallpox. It spreads through close physical contact with an infected person’s lesions, bodily fluids, or contaminated items like bedding. Respiratory droplets can also transmit the virus, though this requires prolonged face-to-face interaction.
During the 2022 outbreak, a striking pattern emerged: over 95% of cases occurred in men who reported recent sexual contact with other men, according to the World Health Organization (WHO). This led some health agencies to label sexual activity as the primary driver of transmission. However, experts caution that this doesn’t mean mpox is exclusively an STD.
Key Transmission Routes:
- Direct skin-to-skin contact with lesions during sex, hugging, or caregiving.
- Sharing towels, clothing, or bedding contaminated with fluid from sores.
- Respiratory droplets during prolonged close contact (e.g., kissing).
- Mother-to-child transmission during pregnancy or childbirth.
“Labeling mpox as an STD oversimplifies its transmission,” says Dr. Jay Varma, an epidemiologist at Weill Cornell Medical College. “Unlike HIV or syphilis, which require sexual fluids to spread, mpox can infect anyone through non-sexual close contact.”
The Case for Calling Mpox an STD
Proponents of classifying mpox as an STD argue that it aligns with observed transmission patterns and could improve prevention efforts. For example:
- Targeted Public Health Messaging: During the 2022 outbreak, countries like the U.S. and U.K. focused vaccination campaigns on LGBTQ+ communities and sexual health clinics. This approach helped reduce cases by 90% within months. “When a disease spreads predominantly through sex, tailoring education to high-risk groups saves lives,” says Dr. John Brooks, a CDC medical epidemiologist.
- Reducing Misinformation: Early media reports often downplayed mpox’s link to sexual networks, leaving MSM communities underprepared. Clear labeling could help people assess their risk accurately.
- Normalizing Sexual Health Discussions: Framing mpox as an STD might reduce stigma by placing it alongside common infections like herpes or HPV.
The Argument Against the STD Label
Critics warn that labeling mpox an STD could do more harm than good:
- Stigma and Discrimination: Historically, diseases linked to marginalized groups (e.g., HIV/AIDS) have fueled prejudice. A 2023 study in The Lancet found that 68% of mpox patients faced harassment or isolation due to misconceptions about transmission.
- Overlooking Non-Sexual Spread: Mpox has infected healthcare workers, children, and non-sexual household contacts. In Nigeria, a 2023 outbreak involved cases traced to communal living spaces, not sexual activity.
- Complacency in the General Population: If mpox is seen as an “STD for gay men,” others might ignore symptoms, delaying diagnosis.
Dr. Boghuma Titanji, an infectious disease specialist at Emory University, explains: “Calling it an STD erases the fact that mpox doesn’t care about your sexual orientation. Anyone can get it through close contact.”
What Do Health Organizations Say?
Major health bodies avoid officially classifying mpox as an STD:
- WHO: Refers to mpox as “spreading through close physical contact, including sexual contact.”
- CDC: States it is “not traditionally an STD” but can spread during sex.
- UNAIDS: Warns against language that stigmatizes LGBTQ+ communities.
These agencies emphasize context-specific guidance. For example, while sexual contact is a key risk factor in outbreaks among MSM, the same may not apply in regions where mpox spreads through household contact.
Lessons From the 2022 Outbreak
The global mpox outbreak peaked in August 2022, with over 91,000 cases reported. Case studies reveal how public health strategies shaped outcomes:
- New York City: Vaccines were distributed at Pride events and LGBTQ+ health centers. Cases dropped by 95% within four months.
- Democratic Republic of Congo (DRC): Mpox is endemic, with most cases linked to rodent contact. Here, vaccination efforts focus on rural communities, not sexual networks.
“One-size-fits-all labels don’t work,” says Anne Rimoin, an epidemiologist at UCLA. “In DRC, mpox is a zoonotic disease. In Europe, it’s a sexual health issue. Context is everything.”
The Role of Vaccines and Treatment
The smallpox vaccine (JYNNEOS) is 85% effective against mpox. However, access remains unequal. During the 2022 outbreak, high-income countries secured most doses, while African nations—where mpox is endemic—received few.
Antiviral drugs like tecovirimat can treat severe cases, but experts stress prevention through education and equitable vaccine distribution.
What’s Next for Mpox?
The debate continues, but most experts agree on these priorities:
- Avoid stigmatizing language in public health campaigns.
- Improve global vaccine access to prevent future outbreaks.
- Educate the public about all transmission routes, not just sexual ones.
As Dr. Rosamund Lewis of WHO notes, “Diseases don’t fit into neat boxes. Our response must be as adaptable as the pathogens we fight.”