People queue outside the Test Positive Aware Network non-profit clinic in Chicago, Illinois, on July 25, 2022 to receive the monkeypox vaccine
Eric Cox | Reuters
The World Health Organization on Wednesday recommended that gay and bisexual men limit the number of sex partners they have to protect themselves from monkeypox and slow transmission of the fast-spreading virus.
WHO monkeypox expert Rosamund Lewis said men who have sex with men are currently the group most at risk of infection. About 99% of cases are men, and at least 95% of those patients are men who have sex with men, Lewis said.
WHO chief Tedros Adhanom Ghebreyesus said it is crucial for health authorities to engage communities of men who have sex with men to reduce transmission of the virus and take care of those infected, while protecting human rights by fighting it protected from stigma and discrimination.
“Right now, for men who have sex with men, that means reducing the number of sexual partners, reconsidering sex with new partners, and sharing contact information with new partners to enable follow-up if necessary,” Tedros said.
Tedros called on social media platforms, tech companies and news organizations to counter harmful information, which he warned would only fuel the outbreak.
“Stigma and discrimination can be as dangerous as any virus and fuel the outbreak. As we have seen with Covid-19 misinformation, this information can spread quickly online,” said the WHO chief.
According to WHO data, more than 18,000 cases of monkeypox have now been reported in 78 countries. About 10% of monkeypox patients have been hospitalized to treat pain from the disease. Five deaths have been reported in Africa, according to the WHO.
The WHO declared a global health emergency in response to the outbreak over the weekend as cases have been rising rapidly. The current outbreak is highly unusual as the virus is spreading widely in Europe and North America where the virus is not normally found. Historically, monkeypox spread at low levels to remote parts of west and central Africa where rodents and other animals carried the virus.
Europe is currently the epicenter of the global outbreak, reporting more than 70% of monkeypox cases. About 25% of monkeypox cases have been reported in the Americas, with the US being the center of the outbreak in the Western Hemisphere, according to WHO and CDC data.
The US has reported more than 3,500 cases of monkeypox in 46 states, Washington DC and Puerto Rico, according to the Centers for Disease Control and Prevention. The United States has the second highest number of monkeypox cases in the world after Spain.
According to WHO and CDC scientists, monkeypox spreads primarily through skin-to-skin contact during sex. Lewis said the virus will have a chance to spread further if people don’t take precautions by limiting the number of sex partners and anonymous sexual contact.
“If there is no intervention in a circumstance where there is regularly a lot of skin contact, perhaps related to multiple partnerships or contacts with anonymous partners, then that would be a no intervention circumstance where the virus can spread more easily,” Lewis said.
Historically, people infected with monkeypox passed the virus on to fewer than one other person on average, which is why previous outbreaks didn’t spread as widely. However, Lewis said that now that global immunity has waned, a person with monkeypox may be able to pass the virus on to more people as smallpox vaccination has become much rarer. Monkeypox is in the same family as smallpox, although it causes a milder disease.
Experts have not been able to determine whether monkeypox is a new type of sexually transmitted infection, although it is clearly transmissible through sex, according to Andy Seale, a WHO consultant specializing in STIs. It’s also unclear whether condoms would help reduce the risk of infection, since monkeypox, like herpes, spreads through close physical contact, Seale said.
“The critical part is really focusing on close, intimate personal contact, prolonged contact that occurs in sex as a key mode of transmission,” Seale said. Scientists in Spain and Italy have discovered monkeypox DNA in semen samples from patients, although it’s unclear if the virus actually spreads that way.
Although monkeypox is primarily spread through sex, anyone can catch the virus through close physical contact. This includes, for example, hugs and kisses within a family, but also shared towels or bed linen that are contaminated. There have been cases of women and children contracting the virus during the current outbreak, although transmission in the wider community appears to be low at this time.
Monkeypox can also spread through respiratory droplets when infected people have lesions in their mouths, although this requires prolonged face-to-face contact. The outbreak could potentially be contained if people limit their exposure risk now, Lewis said.
“It is very important that anyone who has monkeypox can be isolated so that they can protect everyone else who lives in their household or anyone else they may be in contact with,” Lewis said. “Household transmission was the first to discover this and under certain circumstances household transmission can occur.”
According to the US CDC, most people who contract monkeypox recover in two to four weeks. But the virus causes a rash that can be very painful. In the past, monkeypox started with flu-like symptoms and then progressed to a rash that could spread anywhere in the body.
But monkeypox symptoms in the current outbreak were uncommon. Some people develop a rash first, while others have a rash without flu-like symptoms. Many people develop a localized rash on their genitals or anus.