What we know about transmission

Let’s be clear and state three facts.

First of all, anyone can get monkeypox.

Second, the current epidemic is overwhelmingly concentrated among men who have sex with men.

And third, a growing body of evidence and data suggests that sex in these men is the main way monkeypox is currently being spread.

While it is true that there are other ways the virus can be transmitted, acknowledging and reporting these facts is not anti-gay or anti-science, nor is targeting advice to members of this community the one who is currently most at risk. .

More … than 31,000 people worldwide have contracted monkeypox – nearly a third of them in the United States, where the Biden administration has declared a public health emergency. All states except Wyoming have detected at least one case.

And yet, whether out of fear of perpetuating stigma or simply a general reluctance to use the words “anal sex” in headlines, health officials and the media have been extremely hesitant to speak candidly about sex to anyone. is most at risk. In Washington, DC, officials have even expanded vaccine eligibility to include people of all genders in part because of a desire to “[destigmatize] people who might need a vaccine.

Public fears have also been stoked about catching monkeypox while trying on clothes in stores or via rats in the sewers by medical experts who presented themselves online as COVID pseudo-influencers turned monkeypox. (For the record, experts say none of these scenarios are cause for concern.)

Experts say all of this could actually do more harm than good, according to Angie Rasmussen, a virologist at the Canadian Center for Pandemic Research, the Vaccine and Infectious Disease Organization at the University of Saskatchewan.

“The talk around this has gotten so exhausting: watching my friends who are gay health advocates trying to get information and vaccines/treatments for those at risk are battling armchair experts and hunters. influence shouting, ‘AIRBORNE!’ and wringing their hands because their kids get monkeypox in kindergarten,” Rasmussen wrote in a post to BuzzFeed News. “It’s hurting the most at-risk people NOW.”

So what does the data say about people who get monkeypox?

People infected with monkeypox right now are mostly gay, bisexual, or gay men. And when we say massively, we mean it.

In a update last week, the WHO said that of the more than 8,400 cases with known data on sexual orientation, 97.2% were men who have sex with men. Moreover, of the nearly 6,000 types of transmission reported, 91.5% of cases were from sexual intercourse.

“With the exception of countries [in the] regions of West and Central Africa, the current outbreak of monkeypox continues to affect primarily men who have sex with men who have reported recent sex with one or more partners,” said the WHO. “At this time, there are no signals suggesting sustained transmission beyond these networks.”

In a New England Journal of Medicine study published last month which reviewed more than 500 cases of monkeypox in 16 countries, 98% of patients were gay or bisexual men. Another study published on July 28 in the British medical journal BMJ involved 197 patients with monkeypox at a sexual health clinic in London. All but one of these men – and they were all men – identified as gay, bisexual or have sex with men.

In the United States, the data is the same. CDC data from July 25 shows that 99.1% of cases involve patients designated male at birth, and 99% of these men reported having recently had sexual contact with another man.

To explain the concentration of monkeypox among these men, experts say it’s important to think of them not as individuals, but as communities or networks of people who come into close contact with each other.

In other words, the virus hasn’t become more contagious – it just made its way into a new network of people.

“I think it’s really about the ability of the virus to exploit network effects and close contact between individuals,” said Amesh Adalja, principal investigator at the Johns Hopkins University Center for Health Security, “and uses amplifying events like raves – where many people may have had multiple close contacts with multiple partners, and some of them anonymous – and that allowed the virus to spread in ways it really hadn’t had the chance to before.

“He probably always had that potential,” Adalja said. “He just needed to get into a network like this.”

What do these data tell us about the way is monkeypox spreading?

Speak CDCthere is three main ways to get monkeypox: direct skin-to-skin contact with an infected person; touching contaminated surfaces, objects or tissues (i.e. contaminated objects); and contact with respiratory secretions such as mucus (aerosols).

But given that this current outbreak is spreading so primarily among these networks of men who sleep together, experts say prolonged skin-to-skin contact during sex is to blame for most of these cases.

“Based on the data we have, it seems pretty compelling to me that sex plays a dominant role in the spread of monkeypox, along with the fact that these patients may have had sex with multiple partners,” said Gerardo Chowell, epidemiologist at Georgia State. Atlanta University School of Public Health, told BuzzFeed News. “And that’s probably why we haven’t seen as many cases in heterosexuals.”

Rasmussen said that while fomites and aerosols were huge drivers of monkeypox, the data would show many cases occurring outside of gay men, bisexual men, or men who have sex with men (GBMSM ). “Not all transmissions are associated with sex, but most are,” Rasmussen said. “If this were transmitted more commonly by aerosols, fomites or accidental contact, we would see way more domestic transmission and spread in the wider community.

“GBMSMs do not live in isolation: they have children, families, colleagues. We would see more cases in these people if the spread was not primarily due to sex,” Rasmussen added. “But again, there’s some non-sexual transmission occurs, but not that much.

“It would likely spread among heterosexuals as well if it established itself within those sexual networks.”

For its part, the New York Department of Health, which counted more than 2,000 cases of monkeypox, lists the three possible modes of transmission on its website but first clearly states: “In the current epidemic, the monkeypox virus is mainly spread during oral, anal and vaginal intercourse and other intimate contact, such as rimming, cuddling, kisses, bites, hugs and massages.”

How is monkeypox transmitted through sex?

Experts believe that it takes more than light skin contact or a handshake with an infected person to catch monkeypox; what is needed is constant rubbing against a person who has rashes, scabs, or lesions, or said person’s bodily fluids. The most obvious and easiest way for this to happen is during sex, but dancing or rubbing against a shirtless person at a circuit party also presents some risk.

The role of sex in the spread of monkeypox seems to have been evident for several years now.

This current outbreak of monkeypox appears to be linked to the one identified in 2017 in Nigeria, which now appears to have spread globally.

At the time, puzzled scientists wondered why so many men in their 20s and 30s were getting sick and developing rashes not on their faces and extremities, but rather on their genitals. They soon discovered that many of these patients had exhibited high-risk sexual behaviors, including sleeping with multiple partners and with sex workers.

“Although the role of sexual transmission of human monkeypox is not established, sexual transmission is plausible in some of these patients through close, skin-to-skin contact during intercourse or through transmission via genital secretions,” Dimie said. Ogoina, professor of medicine and infectious diseases at the University of the Niger Delta, wrote with colleagues in a Medical Journal 2019.

Other studies related to this current global epidemic have reinforced this idea, Ogoina wrote in a new analysis published in the Lancet medical journal just last week.

Ogoina made special mention of another Lancet study published earlier this month by Spanish scientists on 181 monkeypox patients, 92% of whom had GBMSM. The researchers found “significantly higher” viral loads, or amounts of monkeypox virus, on swabs from lesions on patients than in their respiratory samples.

Additionally, more than three-quarters of patients had lesions around the anus or genitals, while more than 40% had lesions in or around the mouth. Forty-five patients also had proctitis, or inflammation of the lining of the rectum, and all but four of these men had had receptive anal sex.

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