Could Monkeypox Become an STD?

Scientists are continuing to investigate the characteristics of monkeypox as the number of cases increases in the U.S. and around the world. Of note is the sexual transmission of the virus, which might lead some people to wonder if monkeypox is a sexually transmitted disease (STD).

Monkeypox, a virus that causes an infectious body rash, amongst other symptoms, occurs primarily in West and Central Africa. This year, for the first time ever, it has begun spreading around the world and infecting people with no travel links to Africa.

Many of the current monkeypox cases have affected communities of men who have sex with men (MSM), with these communities in particular being prioritized for vaccines in the U.S.

There are many potential factors that may contribute to this, and monkeypox is not exclusive to these groups. Back in May, World Health Organization (WHO) STD expert Andy Seale said that monkeypox "is not a gay disease" despite some people on social media labeling it as such.

Couple with condom
A stock photo shows a couple lying on a bed while a man takes a condom out of a packet. Referring to monkeypox as an STD might be harmful to preventing its spread, one expert has said. Wavebreakmedia/Getty

Indeed, experts have said that it is perfectly possible for heterosexual people to contract monkeypox since it is spread through direct contact with an infectious rash or bodily fluids as well as through prolonged face-to-face contact and contact with contaminated objects.

Factors such as closely-interconnected MSM groups, levels of polyamory and sheer chance may all contribute to the current infection landscape.

Regarding general sexual spread, some experts are concerned that monkeypox could become an entrenched STD like gonorrhea or HIV.

At the same time, a number of experts don't think monkeypox behaves like an STD. Although at least one study has found viral DNA to be present in semen as well as nasal and saliva samples, it's still unclear if the virus can actually spread via semen.

According to many experts, the reason monkeypox spreads in sexual communities is that sex requires close proximity, which enables spread through contact and not necessarily through sex itself.

"An STD is one where intimate, sexual contact is critical to the transmission—where sexual acts are central to the transmission," Rowland Kao, the Sir Timothy O'Shea Professor of Veterinary Epidemiology and Data Science at the University of Edinburgh, told Newsweek via the Science Media Centre. "Some infections are transmitted by any type of close contact, of which sexual activity is one. Monkeypox is one of those—it's the close contact that matters, not the sexual activity itself."

Michael Skinner, reader in virology at Imperial College London, echoed the point.

"For me, what defines an STD is a disease that is transmitted obligately or almost exclusively by the sexual route," he told Newsweek. "Everything we know about monkeypox strongly indicates it would not meet that definition."

Paul Hunter, professor of health protection at the University of East Anglia's Norwich School of Medicine, even suggested that labeling monkeypox as an STD could actually be damaging to infection control measures.

Hunter told Newsweek: "My uneasiness about labeling it as an STD is that for most STDs wearing a condom or avoiding penetration or direct oral-anal/oral-genital contact is a good way of preventing transmission. But for monkeypox even just naked cuddling is a big risk. So labelling it an STD could actually work against control if people felt they just had to wear a condom."

An entrenched disease

Whether monkeypox could become entrenched as a virus more generally is a different question, and one that some experts think is certainly possible.

Dr Denise Dewald is a pediatric specialist at University Hospitals Cleveland Medical Center in Ohio. On Friday, she wrote on Twitter that she believes monkeypox will become an entrenched disease in the general population but that it is not an STD.

"It is not an STD. It is like MRSA," she wrote. "This isn't rocket science."

On the spread of monkeypox more generally, Skinner said: "I'd probably think that 'nipping it in the bud' would have had to be a lot earlier than where we are now, such that the opportunity had actually already passed by the time we discovered this outbreak."

"The ability of the virus to spread via inhalation of droplets or dust from dried lesions as well as by skin-to-skin contact, and the fact that the virus is quite stable in the environment, means that we have to be vigilant, especially as initial diagnosis might be delayed."

Hunter said it is "certainly possible" that monkeypox could become an entrenched disease outside of Africa, though he also added society has the tools to stop this from happening.

"Within the endemic African countries, I doubt we will ever prevent monkeypox occurring, though vaccination would reduce the risk," he said. "As long as monkeypox continues to occur in Africa we are likely to see further reintroductions into rich countries in future."

"Whether population immunization of African populations is justified has to be a decision by those nations. It should not be recommended solely on the basis of protecting Western populations."