NEW YORK (AP) — For most of the six decades that monkeypox has been known to affect people, it was not known as a disease that is spread through sex. Now that has changed.
The current outbreak is by far the largest involving the virus, and it has been designated a global emergency.. So far, officials say, all evidence points to the disease spreading primarily through networks of men who have sex with men.
“It’s clearly spreading as an STI (sexually transmitted infection) at this point,” said Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security.
To protect those most at risk while trying to contain the spread, public health agencies are focusing their attention on these men — and attacking the virus based on its current behavior.
On Wednesday, the head of the World Health Organization advised men at risk of monkeypox to consider reducing their sexual partners “for the time being”.
But this is a complicated epidemic that can change in how it spreads and which population groups are most affected. There is also debate over whether monkeypox should be classified as a sexually transmitted disease, with some critics complaining that the term creates stigma and could be used to defame gay and bisexual men.
Monkeypox can also be spread non-sexually, and just using condoms or other typical measures isn’t enough to stop STDs, say Inglesby and other experts.
Here’s what we know.
WHAT MAKES SOMETHING AN STD?
A sexually transmitted disease is generally defined as a disease that is spread primarily through sexual contact. But some STDs can also be spread in other ways. HIV can be spread through shared needles. Syphilis can be spread by kissing. A common sexual infection caused by parasites called trichomoniasis is spread by sharing wet, moist objects like sponges or towels.
Monkeypox doesn’t usually spread easily among people, and experts are still trying to figure out exactly how it travels from person to person. In Africa, where small outbreaks have been common for years, people have been infected by bites from rodents or small animals.
But in May, cases began to appear in Europe, the United States and elsewhere that showed a clear pattern of infection through intimate contact with an infected person, like many other sexually transmitted diseases.
Public health workers who respond to outbreaks play an important role in how they are supervised. Much of the work on monkeypox has been done by professionals who operate sexual health clinics or specialize in STDs.
Indeed, the US government’s response must be led by people with this expertise, said David C. Harvey, executive director of the National Coalition of STD Directors.
“The field of STDs has a wealth of knowledge and expertise in these areas developed over decades to combat various epidemics and diseases affecting the very communities…we see monkeypox wreaking havoc today,” said Harvey in a statement.
WHO GETS MONKEYPOX?
WHO officials said last week that 99% of all monkeypox cases beyond Africa are in men, and of those, 98% are in men who have sex with men. . Experts suspect monkeypox outbreaks in Europe and North America were sparked by sex at two raves in Belgium and Spain.
The statistics are the same for cases reported in the United States, according to the Centers for Disease Control and Prevention. As in Europe, cases have also emerged in other groups, including at least 13 people who were female at birth and at least two children..
Last week, the New England Journal of Medicine published a study hundreds of monkeypox infections in 16 countries. It revealed that the suspected means of transmission in 95% of cases was close sexual contact, as reported by doctors. The researchers noted that it was impossible to confirm sexual transmission.
This idea appears to be further supported by the finding that most men had lesions in the genital or anal areas or in the mouth – areas of sexual contact, the researchers said.
WHY IS THERE A DEBATE CALLING IT AN STD?
Although there is broad consensus among health officials that monkeypox is transmitted through sex, some experts debate whether to call it an STD. They fear the term unfairly stigmatizes and undermines efforts to identify infections and bring the outbreak under control.
When a disease is defined as a sexually transmitted infection that primarily affects men who have sex with men, many people may begin to think of it as “a gay disease” that poses no risk to them, Jason Farley said. , an epidemiologist at the Johns Hopkins School of Nursing.
This happened at the start of the AIDS epidemic in the 1980s, which contributed to the spread of HIV to other groups. Farley said.
“We don’t learn anything from our history,” said Farley, who is gay.
The WHO recommendation that at-risk men limit their sexual partners is sound public health advice, he said. But it also amplifies “the message that this is a gay disease,” he said.
“It’s the dividing line between having a public health approach that focuses on the epidemiology of today, versus the likelihood of the continued emergence of new cases in” the community at large, a- he declared.
“Monkeypox is not a sexually transmitted infection,” he said. “It’s an infection that can be transmitted through sexual contact.”
WHAT DO WE KNOW ABOUT TRANSMISSION?
Some researchers have found evidence of the monkeypox virus in semen. A study in Spain have found monkeypox virus DNA in the semen of some infected men, as well as in saliva and other bodily fluids. But the study did not answer whether the virus was actually spread through semen.
Sorting this out could affect understanding not just how men spread infection, but also how long they might be contagious. Evidence of some other viruses – like Ebola and Zika – has been found in the semen of some men months after they were thought to be fully cured.
Meanwhile, scientists believe the main route of transmission during the current outbreak has been skin-to-skin contact during sex with someone who has symptoms. In this respect, it is similar to herpes, some experts have noted.
The virus can also spread through saliva and respiratory droplets during prolonged face-to-face contact, such as kissing and hugging — a kind of spread that can happen outside of sex.
Researchers are studying how often and in what situations this kind of spread might occur, said Christopher Mores, professor of global health at George Washington University.
“We would be doing ourselves a disservice by trying to exclude anything from the realm of possibility at this point,” he said.
Officials also say people can catch monkeypox by touching objects that have previously touched an infected person’s rash or bodily fluids, such as towels or sheets. This is thought to explain the infections of American children.
WHY ARE THESE DETAILS IMPORTANT?
Understanding exactly how monkeypox spreads is important to give people the information they need to protect themselves, health officials say.
That said, health officials believe those currently most at risk are gay or bisexual men who have sex with multiple partners. This understanding has shaped much of the work to contain the outbreak, including prioritizing the supply of vaccines and treatments.
Government ships monkeypox vaccine, but supply is limited. So far, it has only been recommended as post-exposure treatment or for people who have had multiple sexual partners in the last two weeks in a place where cases of monkeypox have been reported.
The vaccine is new and officials are trying to gather data on its exact effectiveness.
Associated Press writer Jamey Keaten in Geneva contributed to this report.
The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute Department of Science Education. The AP is solely responsible for all content.