The mode of transmission of monkeypox is known, yet it remains difficult to explain why it affects gay and bisexual men more. What is the status of research on this subject? We answer. The data shows that 97% of those infected are gay men. What can explain this figure?
As of August 4, 2022, 2,423 confirmed cases of monkeypox have been reported in the United States. While this number continues to rise, the disease seems to affect men more severely, in particular homosexual and bisexual men. Is it possible to explain this phenomenon? So, without further ado, let’s dive into this blog to learn more about the subject.
A new phenomenon
This is not the first monkeypox epidemic, but it is the first time it has reached such a scale on the European continent. “In the epidemics that have occurred so far, there has not been a sustained chain of human-to-human transmission. We were talking more about micro-epidemics,” says Prof. Pierre Tattevin, an infectious diseases specialist at the University Hospital of Rennes, whom we interviewed.
Outside the African continent, “99% of the reported cases are men,” said Dr. Rosamund Lewis, WHO’s a lead expert on monkeypox, on Wednesday, July 20, 2022, and 98% of them are “men who have sex with men, and mainly those with multiple recent partners, new or anonymous.
These data are also new. In previous epidemics, cases were shared between men and women. However, according to the sequencing, the virus is not very different from the one observed in West Africa. What is special is the population in which it is spreading.
The data shows that 97% of those infected are homosexual men. What can explain this figure? As of August 4, 2022, 2,423 confirmed cases of monkeypox have been reported in France. While this number continues to increase, the disease seems to affect men more severely, in particular homosexual and bisexual men.
A new phenomenon
This is not the first epidemic of monkeypox, but it is the first time that it has reached such a scale on the European continent. In the epidemics that have occurred so far, there has not been a sustained chain of human-to-human transmission. Rather, they have been micro-epidemics.
Outside the African continent, “99% of the cases identified are men,” said Dr. Rosamund Lewis, WHO’s a lead expert on monkeypox, on Wednesday, July 20, 2022, and 98% of them are “men who have sex with men, and mainly those with multiple recent partners, new or anonymous.”
These data are also new. In previous outbreaks, cases were split between men and women. Yet, according to the sequencing, the virus is not very different from that seen in West Africa. What is particular is the population in which it spreads.
The origin of the outbreaks
Several possible explanations exist for the overrepresentation of homosexual and bisexual men among those infected with monkeypox. First, it is possible that the outbreaks originated in the homosexual community.
The virus spread in a community with more partners and exchanges, which may have allowed the virus to spread more rapidly. Multiple sexual partners are the main factor in the spread of the virus, regardless of sexual orientation: 74% of reported cases said they had more than two sexual partners in the three weeks before the onset of symptoms.
Sexual intercourse is the ideal way to have prolonged contact; everything is in place for the virus to pass from one person to another. And when you have several partners, you multiply the chances of catching the virus but also of spreading it. That’s how the epidemic can progress so quickly.
Symptoms of the disease are not the same for everyone and can sometimes go unnoticed or be mistaken for another condition. The lesions may not be characteristic, and some spots may look more like herpes, for example. Some people may not have had the reflex to see a doctor immediately. Other factors may have allowed the disease to spread rapidly among gay and bisexual men.
A sexually transmitted infection?
Human-to-human transmission occurs through prolonged face-to-face contact with respiratory droplets, or through direct contact with an infected person, through bodily fluids, lesions caused by the disease, or internal mucous membranes. Sexual intercourse […] meets these conditions for contamination, and having several partners increases the risk of being exposed to the virus.
But then, can this disease be considered a sexually transmitted infection (STI)? This is a very semantic debate. If we cut out STI, it means sexually transmitted. Therefore that can be transmitted in a sexual way. So yes, it can be transmitted sexually, but it is not only that. Contamination can also occur through skin-to-skin contact outside of a sexual act or through very prolonged proximity via the respiratory route.
How to protect yourself?
The condom, if it is strongly recommended against STI, is not enough to protect oneself from monkeypox. “As these transmissions are also skin-to-skin, it is not because a person puts on a condom that he or she will not catch the disease. If people have lesions on their hands, buttocks, stomach… It will not protect them,” warns the infectiologist.
In addition to vaccination, which is recommended for people at risk, other reflexes must be adopted to avoid being contaminated. And everyone is concerned by these recommendations. It is a disease that can be painful. The most important thing today is to take precautions, not to have multiple partners for a few weeks. This will be much more effective than trying to vaccinate everyone.
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