NEW YORK (AP) – For most of the six decades that monkeypox has been known to affect people, it was not known as a sexually transmitted disease. Now that has changed.
The current outbreak is by far the largest involving the virus, and has been designated a global emergency. So far, officials say, all evidence indicates the disease has spread primarily through networks of men who have sex with men.
“It’s clearly spreading as an STI (sexually transmitted infection) right now,” 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 how it behaves now.
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 outbreak that can change in its spread and which population groups are most affected. There is also debate over whether monkeypox should be called a sexually transmitted disease, with some critics complaining that the term creates a stigma and could be used to vilify gay and bisexual men.
Monkey pox can also be spread in nonsexual ways, and using condoms or other typical measures isn’t enough to stop STDs, Inglesby and other experts say.
This is what we know.
WHAT MAKES SOMETHING an STD?
A sexually transmitted disease is commonly defined as one that is transmitted primarily through sexual contact. But some STDs can also be transmitted in other ways. HIV can be spread through shared needles. Syphilis can be spread through kissing. A common sexually transmitted infection caused by parasites called trichomoniasis has been found to be spread by sharing wet, damp objects such as sponges or towels.
Monkey pox has not spread easily between people, and experts are still trying to understand exactly how it moves 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 emerge 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 framed. 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 needs to be led by people with that experience, said David C. Harvey, executive director of the National Coalition of STD Directors.
“The STD field has a wealth of knowledge and experience in these areas developed over decades of fighting various outbreaks and diseases that affect the same communities … we’re seeing monkeypox affecting today,” he said Harvey in a statement.
WHO IS MONKEYPOX AGAINST?
WHO officials said last week that 99 percent of all smallpox cases outside of Africa were in men, and that of those, 98 percent involved men who have sex with men. Experts suspect that monkeypox outbreaks in Europe and North America were ignited by sex in two radishes 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, 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 of hundreds of monkeypox infections in 16 countries. The suspected means of transmission in 95% of cases was found to be close sexual contact, doctors reported. The researchers noted that it was impossible to confirm sexual transmission.
This idea seemed to be further supported by the finding that most of the 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 ABOUT CALLING IT ETS?
Although there is broad agreement among health officials that monkeypox is transmitted during sexual encounters, some experts debate whether it should be called an STD. They worry that the term is unfairly stigmatizing and could undermine efforts to identify infections and tame the outbreak.
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. , Johns epidemiologist. Hopkins School of Nursing.
This is what happened in the early days 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 men at risk 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.
“That’s the fine line between having a public health approach focused on the epidemiology of now, versus the likelihood of continued emergence of new cases in the wider community,” he said.
“Monkey pox is not a sexually transmitted infection,” he said. “It is an infection that can be transmitted through sexual contact.”
WHAT IS KNOWN ABOUT THE TRANSMISSION?
Some researchers have found evidence of the monkeypox virus in semen. A study in Spain found monkeypox virus DNA in the semen of some infected men, as well as in saliva and other body fluids. But the study did not answer whether the virus actually spread through semen.
Resolving this could affect understanding not only of how men spread the infection, but also how long they might be contagious. Evidence of some other viruses, such as Ebola and Zika, has been found in the semen of some men months after they were thought to have fully recovered.
Meanwhile, scientists believe the main route of transmission during the current outbreak has been skin-to-skin contact during sexual encounters with someone who has symptoms. In this sense, it is similar to herpes, some experts noted.
The virus can also spread through saliva and respiratory droplets during prolonged face-to-face contact, such as kissing and hugging, a type of spread that can occur outside of sex.
Researchers are exploring how often and in what situations this kind of spread might occur, said Christopher Mores, a professor of global health at George Washington University.
“We would be doing ourselves a disservice to try to exclude anything from the realm of possibility at this point,” he said.
Officials also say people can catch monkeypox by touching items that previously touched an infected person’s rash or body fluids, such as towels or sheets. This is thought to explain the infections in American children.
WHY ARE THESE DETAILS IMPORTANT?
It’s important to understand exactly how monkeypox spreads to give people the information they need to protect themselves, health officials say.
That said, health officials believe those currently at highest 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.
The government has sent a vaccine against monkey pox, but the supply is limited. So far it has only been recommended as a post-exposure treatment or for people who have had multiple sexual partners in the past two weeks in a place where cases of monkeypox have been reported.
The vaccine is new, and officials are trying to gather data on exactly how it works.
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Associated Press writer Jamey Keaten in Geneva contributed to this report.
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The Associated Press Department of Health and Science is supported by the Department of Science Education at the Howard Hughes Medical Institute. The AP is solely responsible for all content.