Monkeypox: An expert explains what gay and bisexual men need to know

Since early May, more than 23,000 cases of monkeypox have been reported worldwide. This is the largest global outbreak of the disease to date.

Cases have now been reported from 78 countries, including the UK, Spain, Germany, France, the US and Brazil. Given the scale of the outbreak, the World Health Organization (WHO) has now declared the current monkeypox epidemic a global health emergency.

Although anyone can contract monkeypox, the current outbreak is overwhelmingly affecting sexually active gay, bisexual and other men who have sex with men. In fact, our most recent study looking at 528 monkeypox infections since the outbreak began found that 98% of those infections had occurred in this group. Here’s what these men need to know.

How it spreads

Monkeypox is a disease caused by infection with the human monkeypox virus, which is from the same virus family as smallpox. In fact, the symptoms are quite similar to smallpox and include fever, headache, muscle aches, chills, cold symptoms (like a cough or sore throat).

The symptoms are also accompanied by a rash that appears in blisters on the face, genitals, chest and back, and hands and feet. Some people also experience very painful sores in their mouth or buttocks. In most people, the disease usually goes away within two to three weeks.

Monkeypox is spread through close physical contact with an infected person. Typically, this means skin-to-skin contact, particularly contact with the rashes and skin lesions caused by the disease. But it can also be spread through large respiratory droplets (like coughing and sneezing).

It can also spread through contact with sheets, towels, or other fabrics that have come into contact with the infected person’s wounds. We know that the virus can persist on surfaces for a long time – sometimes up to several weeks.

According to our study, 95% of monkeypox infections to date have been transmitted through sexual contact. About 95% of the people in our study had a rash, mostly on the genitals. About 41% had wounds on the body (including in the anus or mouth).

Our research also found that monkeypox virus was found in more than 90% of the semen samples we tested. However, we do not yet know whether the virus in semen is contagious.

All of this could explain why the virus mainly spreads through networks of men who have sex with men.

It is worth noting that the virus can spread through any contact with lesions or large respiratory droplets of an infected person. That means it can spread in households through any close personal contact with an infected person — not just through sexual intimacy. However, during the current outbreak, our study suggests that this type of non-sexual transmission has so far been very rare, accounting for less than 1% of cases.

provide protection

Many countries offer vaccinations for sexually active gay and bisexual men, who are at greatest risk of contracting the disease. Research suggests that the vaccine used prior to exposure can provide around 85% protection against infection. If the vaccine is given between four and 14 days after exposure to monkeypox, it may be able to relieve symptoms of the disease.

The WHO has also recommended that risk groups should limit the number of their sexual partners and take steps to protect themselves from contact. However, the abstinence recommendation really doesn’t go far enough, especially since we already have a vaccine that can prevent monkeypox. This is why getting vaccinated (and making sure everyone has equal access to those vaccines) is so important.

Given that the epidemic currently affects almost exclusively men who have sex with men, there is a need to direct accurate and relevant public health messages and work with the community to develop acceptable interventions to limit damage and further spread to prevent.

One of the difficulties is that gay and bisexual men represent a marginalized community that has already faced stigma and discrimination, particularly during the HIV/AIDS pandemic. Nobody wants to repeat that.

However, public health messages are most effective when they target people who are most at risk of a particular condition. Some even argue that messaging wasn’t well-targeted during this outbreak.

While public health agencies such as the WHO, CDC, ECDC and UKHSA have already done a lot to provide clear, non-stigmatizing guidance to risk groups, it can be important to ensure that this information is now being disseminated where it will have the greatest impact – such as on dating apps.

There is a small window to help stem the spread of monkeypox – and it may already be closed. There have already been reports of infections in both women and children. But the fact that the disease still seems to mainly occur in one group means that with the right interventions, the course of the outbreak could still be altered and that group protected.

The most important thing now is to ensure that all countries have equal access to vaccines and treatments to protect against further spread of infection. The WHO declaration of a worldwide pandemic will hopefully serve to coordinate the global response and open up the possibility of mass-producing multiple vaccines with access for all. The question is whether it will be fast enough.