Today in Clinical Infectious Diseases two opposing commentaries debate whether or not mpox should be considered a sexually transmitted infection (STI).
While the 2022 global outbreak has largely been defined by sexual transmission among men who have sex with men (MSM), the disease has historically been defined via household contact, or animal-to-human contact via the ingestion of bushmeat.
Three requirements fulfilled
In the first article, physicians from Brigham & Women's Hospital in Boston and from California use epidemiologic factors to demonstrate causality. They suggest that, because the virus can be isolated from sexual fluids and because of the temporal association between sexual activity and subsequent infection, mpox should be considered an STI.
"The association between Mpox and sexual transmission thus far fulfills three important requisites: strong association, consistency across time and geographic location, and temporality," they write.
The authors said this definition should certainly be adopted in Europe and North America, but sexual transmission is not the dominant transmission mode in Africa, so designating the virus as an STI in that region may be unhelpful.
The association between Mpox and sexual transmission thus far fulfills three important requisites: strong association, consistency across time and geographic location, and temporality
Need for historical context
The second commentary says that labeling mpox as an STI ignores the historical impact of the disease in Central and West Africa. "The majority of historical outbreaks have been localized with little to no sexual transmission noted, significantly differing from what is seen currently," the authors write.
By labeling the virus an STI, less attention could be given to pediatric cases or tracking the disease in other vulnerable groups who are more commonly affected in Africa, add the authors, Aniruddha Hazra, MD, of University of Chicago Medicine, and Joseph N Cherabie, MD, of Washington University School of Medicine in St. Louis.
The majority of historical outbreaks have been localized with little to no sexual transmission noted, significantly differing from what is seen currently
In September, CIDRAP published a commentary by H. Hunter Handsfield, MD, stating that mpox is certainly an STI, as sexual activity has been implicated in 95% of US cases, and MSM must be properly educated on the risks of contracting the virus.