How is monkeypox sexually transmitted?

As the world still grapples with the latest wave of COVID-19, another viral disease has drawn attention: monkeypox.

The virus, previously circulating primarily in West and Central Africa, has now been declared a public health emergency by the Biden administration. Last month, the World Health Organization also declared the outbreak a public health emergency of international concern.

RELATED: As the monkeypox outbreak spreads, these images can help you identify the symptoms

Data from August 4 shows that more than 26,800 cases were reported in 88 countries, including at least 7,102 cases in the United States, according to the US Centers for Disease Control and Prevention.

Research shows that the majority of infections in this current outbreak have been spread through sexual activity, particularly sex between men, making this outbreak different from previous ones.

What is monkeypox and where does it come from?

Monkeypox is a viral disease caused by the monkeypox virus (MPV), which can be transmitted from animals to humans or between humans. The monkeypox virus is in the same family as the smallpox virus and is not related to chickenpox, according to the CDC.

A textbook case of monkeypox typically begins with flu-like symptoms such as fever, fatigue or muscle aches and swollen lymph nodes, and usually within five days patients develop a rash of painful raised lesions, Dr Scott Roberts, associate medical director of infection prevention for the Yale School of Medicine, told TODAY. The rash usually starts on the face and mouth and then spreads to other parts of the body. The lesions usually start out as pimples, then fill with pus and eventually scab or scab over.

However, in this outbreak, the symptoms have looked different from the classic clinical picture of monkeypox, NBC News reported. Many patients have developed lesions on their genitals or other parts of their body prior to flu-like symptoms or never develop flu-like symptoms.

So far, monkeypox outbreaks have been smaller.

In previous cases of person-to-person transmission in Africa, “one person would get monkeypox, then it could spread within the household from eating and living together, and it wouldn’t spread further from that,” said Dr. Stuart N. Isaacs, an infectious disease specialist and associate professor of medicine at the University of California Perelman School of Medicine. Pennsylvania. THIS DAY. “So what you’re seeing now is something very unusual in the amount of person-to-person spread that’s happening.”

According to the CDC, prior to the 2022 outbreak, nearly all monkeypox cases outside of Africa were related to travel to endemic countries or imported animals.

How is monkeypox spread through sex?

“The predominant mode of transmission is close skin-to-skin contact,” Dr. Paul Adamson, an infectious disease physician and assistant clinical professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, told TODAY. .

Skin-to-skin contact can occur during sexual activity, such as oral, vaginal, or anal sex, and foreplay. But transmission can also occur during other intimate activities like kissing, hugging or massaging, according to the CDC, since the virus can spread through direct contact with an infected person’s sores or scabs and bodily fluids.

“The lesion itself is really full of virus, and that’s mainly how it spreads,” Roberts said, adding that the virus is thought to enter the body through mucous membranes, such as those in the mouth, eyes, the genitals and rectum, or a break in the skin. (In a nonsexual scenario, a person can get monkeypox by touching a lesion with their hand and then touching their mouth or eyes, Roberts said.)

Monkeypox sores are most likely to arise where the virus has entered the body, Adamson added, but they can appear anywhere on the body after the rash begins: “Some patients we’ve seen have the predominant number of lesions on their genitals, but they are also finding lesions in other places, such as on the soles of the feet or on the chest or arms.”

The virus can also be spread through contaminated objects or fabrics and respiratory secretions, which can also be involved in sexual activity, experts noted. (For the virus to enter through the respiratory tract, prolonged contact, defined by the CDC as within 6 feet for three hours, is necessary, according to Roberts.)

“In general, what we’ve seen so far has been sexual transmission, and we think that’s because it provides a certain type of closeness that allows MPV to spread,” said Dr. Andrew Goodman, medical director of Callen-Lorde. Community. Health Center in New York City, said TODAY.

So given the way monkeypox can spread, condoms will not prevent transmission.

“It is possible that the use of condoms reduces the risk of injury to the penis and anus, to the rectum… but condoms will not necessarily prevent skin-to-skin contact in other areas that are outside the area protected by the condom” . Adamson explained.

Also, condoms will not stop the spread of respiratory droplets. Roberts noted. “If someone has a mouth injury and ends up kissing someone, there’s probably a lot of transmission of the virus that way,” he said.

At this time, it is not clear whether monkeypox can be spread through semen or vaginal fluids. A recent study in the New England Journal of Medicine of 528 monkeypox patients diagnosed between April 27 and June 24, 2022, showed “no clear evidence of sexual transmission via seminal or vaginal fluids,” they wrote. the study authors. But scientists are still investigating this, according to the CDC.

Bottom line: “The more viruses you expose yourself to, the greater the chances that you will become infected. … Coming into close, skin-to-skin contact with someone who has lesions that are full of viruses is the highest risk,” Adamson said.

Monkeypox is not a sexually transmitted infection, experts say

“The biggest myth I’ve seen is the unfortunate myth that this is sexually transmitted or only associated with men who have sex with men. That is not the case,” Roberts said.

Although the vast majority of infections in this current outbreak are among men who have sex with men, according to the WHO, anyone can get monkeypox. In the US, there have been five cases of monkeypox in children and one case in a pregnant woman.

“This is not a sexually transmitted disease per se, but it certainly is an ‘intimately transmitted’ disease,” said Dr. W. Ian Lipkin, director of the Center for Infection and Immunity at the Mailman School of Public Health at the Columbia University said TODAY. He stressed that the virus can spread through other types of activities, such as sharing sheets or towels that touched the lesions of an infected person.

So why is monkeypox mainly spread among this community?

“We don’t think there is anything about the ways that (men) have sex with each other that has exclusively caused the spread of this particular virus,” Goodman explained. “The belief that the disproportionate effect for men who have sex with men really has a lot to do with sexual networks, groups that will have this close contact or sexual contact with each other, and not necessarily a lot of activity outside of that group. .”

“We don’t expect that to be exclusive or to be the pattern forever, necessarily,” Goodman continued, adding that transmission between members of the same household has already been documented in this outbreak, indicating that the virus has sprung from the original. affected community.

“We’re thinking a lot about how we talk about this because of stigma and trying to make sure people get the information they need, without adding to or worsening any stigma that has historically plagued our community,” she said.

Right now, public health efforts need to focus on getting resources (including vaccines) to the hardest-hit communities as quickly as possible to slow transmission, Adamson said.

The origins of the current monkeypox outbreak and how it is spreading between people is an active area of ​​research, and guidelines on vaccination or prevention may change as scientists learn more.

“What we know today might be different tomorrow, that’s the challenge,” Goodman said.

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