It's a FAGGOT SPREAD DISEASE! Nothing will change that.
(CNN) -- A hallmark of the ongoing monkeypox outbreak is that
most cases have been linked to sexual activity, and this has
prompted some debate around whether to describe the illness as a
sexually transmitted disease.
"Many infectious diseases, although we will classify them in one
manner of transmission, have multiple mechanisms of
transmission," said Dr. Amesh Adalja, a senior scholar at the
Johns Hopkins Center for Health Security at Johns Hopkins
Bloomberg School of Public Health. Monkeypox may spread
sexually, he noted, but it is clearly spreading through non-
sexual close contact, as well.
"I don't think we have enough information at this point to
completely classify it. I think there's some suggestions, but
there's more study that needs to be done," Adalja said.
"There are other infections -- for example, syphilis -- that
spread through other ways other than sexual transmission," he
said. "Zika virus is a mosquito-borne illness, but it can also
be spread sexually. The question to me is more about making sure
we're clear on what's going on from a physiological standpoint
before you would make that type of claim."
Some experts argue that labeling monkeypox as an STD could be
not only misleading but potentially harmful for public health.
"A negative about suggesting that monkeypox is an STD is that
people who are not having sex think immediately, 'OK, I'm not
going to get it,' " said Dr. Saju Mathew, an Atlanta-based
primary care physician and public health specialist.
"What a lot of people will think is it's like herpes or
gonorrhea or chlamydia -- meaning you have to have sex to get
it. That's not true. So that is why it's dangerous to suggest
that it is only exclusively transmitted via sex. That's
misinformation," he said. "It is transmitted via sex in a
majority of cases, but it's not exclusively transmitted via
intimate contact. You can also get it through non-intimate
contact."
David Harvey, executive director of the National Coalition of
STD Directors, said he and his colleagues refer to monkeypox as
a "sexually associated" infection for now.
"With the data that is available now, we know that the primary
mode of transmission is sexually associated -- contact that is
of a sexual nature. Technically, a sexually transmitted
infection is defined as an exchange of genital fluid that have a
virus or bacteria that is associated with a sexually transmitted
infection," Harvey said. "We need the science that shows
definitively that this is an infection that can be passed by
semen or genital fluids, and the science on that is not quite
clear yet, which is why we're calling this sexually associated."
What makes an STD
STDs, also known as sexually transmitted infections or STIs, are
infections that are passed from one person to another through
sexual contact such as vaginal, oral or anal sex. In some cases,
these infections also can spread through skin-to-skin intimate
contact, as with herpes and HPV.
The long history of STDs dates to archaic times. Some studies
suggest that migrations of modern human ancestors can be
associated with HPV, types of herpes and other sexually
transmitted diseases.
In modern times, a study out of Nigeria was among the first
recent reports to describe the possible sexual transmission of
monkeypox. That country experienced a large outbreak of
monkeypox in humans in September 2017, and the study about it
was published in the journal PLOS One in 2019. Previously, human-
to-human transmission was thought to primarily occur by means of
saliva or respiratory droplets or direct contact with the pus or
crust of lesions.
"There is no formal process to label an infection as an STI or
STD," Kristen Nordlund, a spokesperson for the US Centers for
Disease Control and Prevention, wrote in an email to CNN on
Monday. "Experts generally determine, scientifically, if a
pathogen can be transmitted through sex, in which case it's
called 'sexually transmissible.' And how frequently the
infection is referred to as an STI relates to the proportion of
transmissions accounted for by sex vs some other route -- but
there is no 'rubric' that is used to guide this determination."
She said monkeypox can be described more accurately as "sexually
transmissible," as sex is one of the ways the virus can spread --
but not the only way.
"Sex is a human behavior. If stigma wasn't associated with
infections transmitted through sex, there would be less concern
of implications for saying monkeypox is an STI for people who
are more heavily impacted," Nordlund wrote. "It's also important
to look at this question globally -- and keep in mind the
implications for this label vary depending on where you are in
the world. For example, there are countries where homosexuality
is penalized by prison or even death. Labeling monkeypox as a
STI or STD could have far-reaching consequences in these
countries."
The monkeypox virus can spread during skin-to-skin contact,
direct contact with a monkeypox rash or scabs from an infected
person, or direct contact with their respiratory secretions.
Scientists are still researching whether monkeypox can be spread
through semen or vaginal fluids.
Although the risk is low, there is also some potential for the
virus to spread through items or surfaces like clothing, bedding
or towels that were used by someone with monkeypox.
Mathew said the skin lesions caused by a monkeypox infection
actually could be mistaken for a common STD like herpes or
syphilis, and in some cases, a person with monkeypox could have
coinfections with common sexually transmitted diseases.
When he treated his first monkeypox patient in Atlanta, Mathew
immediately noticed that the person had the typical lesions on
his face. But the 25-year-old man also had buttocks pain, Mathew
said. "He ended up having another STD in addition to monkeypox,"
which was herpes.
Mathew added that about 25% of monkeypox patients in the US have
had STD co-infections.
Harvey said that "when diagnosing monkeypox, you have to test
for monkeypox, but you also have to do the range of other STI
tests to ensure that those are either ruled out or diagnosed as
well."
"We do happen to have the highest sexually transmitted infection
rates in the US, basically in American history. So it's not
surprising that we're diagnosing more STIs in the context of the
current monkeypox outbreak," he said. "Anecdotally, we're
hearing from some of our clinics across the country that they're
seeing rates anywhere of 15% to 40% of coinfections with other
STIs, but we don't have national data on that right now."
The CDC's clinical guidance tells health care providers, "It is
important to comprehensively evaluate patients presenting with
genital or perianal ulcers for STIs. However, co-infections with
monkeypox and STIs have been reported and the presence of an STI
does not rule out monkeypox."
Combating stigma
Any efforts to call monkeypox a sexually transmitted infection
"will only increase stigma and ignores other means of
transmission," Jason Farley, nurse scientist and the inaugural
Leadership and Innovation Endowed Chair at the Johns Hopkins
University School of Nursing, wrote in an email to CNN.
"The virus is spreading among close contacts and sexual networks
within the gay, bisexual and other men who have sex with men
communities. We have also seen spread, although limited thus
far, within households with cases in men, women and children.
The latter is transmission likely through skin-to-skin contact
of parents and children, but environmental contamination
resulting in transmission is also possible," Farley wrote.
"If we look at how the AIDS response unfolded, for example, it
took almost a decade to get the heterosexual community to pay
attention and realize that HIV was not a gay disease," he wrote.
"We cannot allow the same form of inaccurate information to
guide our public health practice today."
Harvey, of the National Coalition of STD Directors, said that
stigma is something STD clinics combat daily and he worries
about the monkeypox outbreak being stigmatized in the context of
it being a sexually associated disease.
"We don't want people to dismiss this as a sexually transmitted
infection, but at some level, this buys into the stigma of
sexually transmitted infections," he said. "And so, for those of
us who work in this field on a full-time basis and deal with
these issues every day in and out, we want to do everything we
can to break down stigma, especially in relation to sexually
transmitted infections, so that we're ensuring people get tested
and treated free of shame or fear."
Overall, whether or not monkeypox is designated an STD, Harvey
said the response to the outbreak is weighing down STD clinics.
"STI and sexual health clinics across the country are bearing
the brunt of responding to testing and treatment needs right now
-- and they don't have additional funding to handle the influx
of patients. We're also seeing other sexually transmitted
infection testing and care already getting disrupted," Harvey
said.
One survey of more than 80 clinics, conducted by the National
Coalition of STD Directors, between July 26 and 29 found that
63% have received referrals from other health care providers for
suspected monkeypox cases, 52% have served people who have been
turned away from other providers, and 40% have incurred
unanticipated expenses for supplies or personnel due to
monkeypox response.
Also, 65% of clinics have had to modify workflows to manage
monkeypox, such as changing from walk-in clinics to appointment-
only, and 22% have had to reduce either symptomatic or
asymptomatic screening for other STIs to prioritize monkeypox
services.
There is "a lack of additional funding, a lack of federal
funding, that can directly support these programs," Harvey said.
"These programs need support for supplies, testing, to pay for
testing, they need additional staff hours and other types of
capacity to help support the response for this outbreak."
By Jacqueline Howard, CNN
https://www.cbsnews.com/baltimore/news/why-calling-monkeypox-an-
std-is-about-more-than-just-a-label/