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Mpox, a viral disease that first gained global attention in 2022, continues to spread across the world, prompting debates among scientists and public health officials. Originally declared a global health emergency by the World Health Organization (WHO) in 2022, the disease has since been detected in multiple countries outside Africa. While the Clade 2b strain has been spreading at a lower rate, a newer and more potent variant, Clade 1b, has been causing outbreaks, particularly in Central Africa, with cases also appearing in Europe, Asia, and North America through travel-related infections.
A major point of discussion among researchers is whether mpox should be classified as a sexually transmitted disease (STD), which would lead to targeted public health measures to control its spread. While some experts argue that classifying mpox as an STD would help focus interventions, others warn that such a label could lead to stigma and hinder containment efforts.
Arguments for Classifying Mpox as an STD
During the 2022 outbreak, studies showed that 98% of diagnosed mpox cases were linked to sexual transmission, primarily among men who have sex with men (MSM) and bisexual individuals. Based on these findings, some scientists suggested that the transmission pattern of mpox aligns with the characteristics of an STD. In a commentary published in the Clinical Infectious Diseases journal in late 2022, researchers including L.T. Allan-Blitz, M. Gandhi, and P. Adamson referenced the Bradford Hill criteria, a set of principles used to determine causal relationships in epidemiology.
According to these researchers, recognizing mpox as an STD would allow for more targeted public health strategies, such as vaccination, testing, and awareness campaigns. They argued that focusing on behavioral modifications within at-risk groups could significantly reduce the number of infections and improve containment efforts.
Concerns Over Stigma and Misclassification
However, other experts believe that classifying mpox as an STD could have negative consequences. In the same Clinical Infectious Diseases issue, researchers Aniruddha Hazra and Joseph N. Cherabie pointed out that historical mpox outbreaks in Africa primarily spread through non-sexual means, such as household contact or animal-to-human transmission through the consumption of bushmeat.
They cautioned that labeling mpox as an STD might divert attention away from pediatric cases and other vulnerable groups. The fear is that a strict focus on sexual transmission could reduce efforts to prevent non-sexual transmissions, which have been common in past outbreaks.
Kerala’s Experience Challenges STD Labeling
In India, Kerala has been at the forefront of managing mpox cases. The state recorded its first case of the clade 1b strain in a traveler returning from the United Arab Emirates. Two more cases were detected in January 2025, but all patients recovered successfully with no secondary infections, reducing fears of a widespread outbreak.
Given Kerala’s experience, public health experts have raised concerns about classifying mpox as an STD. In a Lancet article published in January 2025, specialists T.S. Anish, Anaswara Naveen, and Reghukumar Aravind argued that the stigma associated with mpox could outweigh any potential benefits of targeted interventions. They emphasized that public health strategies should consider the psychological and social impact of labeling mpox as an STD, particularly in communities where stigma around MSM and STDs remains strong.
Dr. Aravind explained, “The success of public health strategies depends on the context in which they are implemented. Currently, people are reporting mild lesions and voluntarily seeking treatment because mpox is seen as an infectious disease. However, if it is labeled an STD, particularly one linked to MSM, people may avoid seeking medical help, leading to further transmission.”
He further pointed out that despite advances in HIV treatment and awareness, stigma against HIV-positive individuals persists. “Unlike HIV, mpox is rarely fatal. If people choose to remain under the radar and avoid treatment, the risk of human-to-human transmission will increase significantly.”
India’s Public Health Approach: A Balanced Strategy
Health officials in Kerala stress the need for an approach that considers India’s social and cultural context. Many mpox patients in Kerala, including those from the 2022 outbreak, were individuals working in the Middle East who returned to India after being infected. Officials fear that classifying mpox as an STD could lead to unintended social consequences, such as marital problems for returning patients.
A Kerala Health Department official explained, “Our information, education, and communication (IEC) strategies are carefully crafted to prevent unnecessary stigma. Attaching labels like STD or MSM to mpox could lead to social problems, including the dissolution of marriages.”
Additionally, a team from the Union Health Ministry that visited Kerala to assess the mpox situation sought to identify the possible sources of infection among patients. However, none of the patients admitted to engaging in sexual activity. The official added, “While we understand the primary transmission route, our priority is treating patients and preventing further spread rather than forcing them to disclose personal details.”
A Complex Debate with No Easy Answers
The debate over whether mpox should be classified as an STD remains unresolved. While targeted interventions could help curb transmission among high-risk groups, the potential for stigma and underreporting poses significant risks. As countries continue to tackle the spread of mpox, public health policies must strike a balance between scientific accuracy and the social realities of affected communities. In India, a cautious and inclusive approach that prioritizes treatment, education, and stigma reduction seems to be the preferred path forward.
