Could Multiple Sclerosis Be A Sexually Transmitted Disease?

Laurie Barclay, MD

September 19, 2002

Sept. 20, 2002 — Multiple sclerosis (MS) or susceptibility to MS may be in part a sexually transmitted disease (STD), according to a scholarly review of epidemiologic evidence published in the October issue of the Journal of Neurology, Neurosurgery and Psychiatry. However, an accompanying editorial presents data arguing against this hypothesis.

"I propose that multiple sclerosis is a sexually transmitted infection acquired principally during adolescence and mainly from infected and not necessarily symptomatic males," writes Chris H. Hawkes, MD, FRCP, from the Institute of Neurology, Queen Square, in London, U.K. "I do not suggest that sexual transmission is the only cause, but that inherited factors create a susceptibility to a sexually transmitted neurotropic agent."

Arguments supporting sexual transmission include migration studies suggesting an agent transmitted in adolescence, and clusters of MS appearing in low prevalence areas following entry of military personnel or other young males.

Primary progressive MS resembles tropical spastic paraplegia, a known STD. Other epidemiologic evidence suggesting sexual transmission of MS is the increased prevalence in drug abusers, similar age of onset and gender distribution to that of STDs, increased incidence in oral contraceptive users, and low rates in morally strict societies.

After the sexual revolution of the 1960s, MS prevalence increased in women. Countries with permissive sexual attitudes have higher MS rates than do other countries in a similar geographical distribution. Family, conjugal pair, twin, and adoption studies of MS are consistent with a sexually transmitted infection.

To test his theory, Hawkes suggests a case-control study of MS patients and their partners, examination of concordant and discordant twin pairs, and research on MS in social groups adhering to a strict moral code, such as Mormons or nuns.

In an accompanying editorial, G.J. Stewart, from the University of Sydney in Australia, notes "substantial difficulties with this hypothesis that can't be overlooked." He argues that adoption studies are not compatible with the STD hypothesis and that familial clustering is explained primarily, if not solely, by genetic predisposition.

Although some migration studies suggest an environmental factor playing some role into early adulthood, close contact allowing infectious spread may not necessarily require sexual contact. Rather than proceeding with case-control studies to test the STD hypothesis, Stewart advocates awaiting the discovery of new infectious organisms and then determining if there is any link of these agents to MS.

"The lack of evidence for transmission of MS risk vertically, by breast milk, or blood transfusion represents a major difference between the epidemiology of MS and known retroviral infections such as HTLV-1 and HIV," Stewart writes. "The suggestions that susceptibility may be linked to sexual permissiveness or that childhood MS could result from child abuse have the potential to cause harm, unless it is made clear that they are pure speculation, based on interpretation of data collected for different purposes."

J Neurol Neurosurg Psychiatry 2002;73:439-443, 358-359.

Reviewed by Gary D. Vogin, MD

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