For most of the six decades that monkeypox has been known to infect humans, it was not known as a sexually transmitted disease. Now that has changed.
The current outbreak is by far the largest of the virus, and has been designated a global emergency. So far, according to the authorities, all the evidence indicates that the disease spreads mainly in networks of men who have sex with other men.
“It’s clearly spreading like an STD (sexually transmitted disease) right now,” said Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security.
To protect people most at risk while trying to contain the spread, public health agencies are turning their attention to these men, and fighting the virus based on their current behavior.
On Wednesday, the director-general of the World Health Organization recommended that men who are at risk of contracting monkeypox consider reducing their sexual partners “for the time being.”
But this is a complicated outbreak that could change how it spreads and which demographics are most affected. There is also debate about whether monkeypox should be considered a sexually transmitted disease (STD), with some critics complaining that the term creates a stigma and could be used to aggravate gay and bisexual men.
Monkeypox can also be transmitted in other ways, and condoms or other measures commonly used to prevent sexually transmitted diseases are not enough, Inglesby and other experts say.
This is what is known:
WHAT TURNS A DISEASE INTO AN STD?
A sexually transmitted disease is commonly defined as one that is spread primarily through sexual contact. But some of them can also be spread in another way. HIV can be transmitted through shared needles. Syphilis can be spread by kissing. It has been known that a common infection caused by parasites, trichomoniasis, can be spread by sharing wet objects such as towels and sponges.
Monkeypox is not usually transmitted between humans, and experts are still trying to understand exactly how it is passed from one person to another. 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 emerge in Europe, the United States and other parts of the world showing a clear pattern of infection through intimate contact with an infected person, like many other sexually transmitted diseases.
Health workers responding to outbreaks have a leading role in public perception. Much of the work around monkeypox has been done by professionals who operate sexual health clinics or specialize in sexually transmitted diseases.
In fact, the US government’s response needs to be led by people with that kind of knowledge, said David C. Harvey, executive director of the National Coalition of HTA Directors.
“The STD field has extensive knowledge and expertise in these areas, developed over decades of fighting various outbreaks and diseases that affect the same communities that are plagued by monkeypox today,” Harvey said in a statement.
WHO IS GETTING SICK WITH MONKEYPOX?
WHO officials said last week that 99% of all monkeypox cases outside Africa were in men, and of those, 98% involved men who have sex with men. Experts suspect monkeypox outbreaks in Europe and North America were triggered by sex at two rave parties in Belgium and Spain.
The statistics are the same for reported cases in the United States, according to the Centers for Disease Control and Prevention (CDC). As in Europe, cases have also been reported in other demographic groups, including at least 13 people who were female at birth and in at least two children.
Last week, the New England Journal of Medicine published a study of hundreds of monkeypox infections in 16 countries. He discovered that the supposed means of contagion in 95% of the cases was close sexual contact, as reported by doctors. The researchers stressed that it was impossible to confirm sexual transmission.
The idea seems to be confirmed by the discovery that most of the men had lesions in the anal, genital or mouth areas, areas of sexual contact, the researchers said.
WHY THE DEBATE ABOUT CATALOGING IT AS STD?
Although there is broad consensus among health authorities that monkeypox is being transmitted during sexual encounters, some experts debate whether it should be called an STD. They worry that the term unfairly stigmatizes and could undermine efforts to identify cases and control the outbreak.
When a disease is defined as a sexually transmitted infection that primarily affects men who have sex with men, many people begin to think of it as “a gay disease” that poses no risk to them, said Jason Farley, epidemiologist at the Johns Hopkins School of Nursing.
That’s what happened in the early days of the AIDS epidemic in the 1980s, contributing 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’s recommendation that men at risk limit their number of sexual partners is sound public health advice, he added. But it also amplifies “the message that this is a gay disease,” she said.
“That’s the fine line between having a public health stance that is focused on current epidemiology, versus the possibility of continued emergence of new infections” in the general community, he said.
“Monkeypox is not a sexually transmitted disease,” he continued. “It is an infection that can be transmitted through sexual contact.”
WHAT IS KNOWN ABOUT ITS CONTAGION MODE?
Some researchers have found evidence of monkeypox virus in semen. A study in Spain found monkeypox virus DNA in the semen of some infected men, as well as in their saliva and other body fluids. But the study didn’t answer whether the virus can actually be spread through semen.
Figuring that out could affect understanding not only of how men spread the infection, but how long they might be contagious. Evidence of some other viruses, such as Ebola and Zika, have also been found in the semen of some men months after they thought they were fully recovered.
Meanwhile, scientists believe that the main route of infection during the current outbreak is skin-to-skin contact during sexual encounters with a person with symptoms. In that sense, it’s similar to herpes, some experts said.
The virus could also be spread through saliva and droplets released during breathing, prolonged face-to-face contact such as kissing and hugging, a type of transmission that does not require sexual contact.
Researchers are looking at how often and in what situations such contagion might occur, said Christopher Mores, a professor of global health at George Washington University.
“We wouldn’t do ourselves any good by ruling out some possibility at this point,” he said.
Officials also say people can get monkeypox by touching something that has previously come into contact with sores or bodily fluids from an infected person, such as towels or sheets. This is believed to explain the cases in children in the United States.
WHY ARE THESE DETAILS IMPORTANT?
It’s important to understand exactly how monkeypox spreads in order to give people the information they need to protect themselves, health officials say.
Having said that, health authorities believe that those most at risk are gay or bisexual men who have sex with multiple partners. That conclusion has shaped much of the response to the virus, including the prioritization of the supply of vaccines and treatments.
The government has been distributing a monkeypox vaccine, but its supply is limited. So far, its application is only recommended as a treatment for previous exposure or in people who have had multiple sexual partners in the last two weeks where monkeypox cases have been reported.
The vaccine is new, and authorities are trying to collect data on how well it works.
Melissa Galbraith is the World News reporter for Globe Live Media. She covers all the major events happening around the World. From Europe to Americas, from Asia to Antarctica, Melissa covers it all. Never miss another Major World Event by bookmarking her author page right here.