According to the main findings of the study, monkeypox is mostly caused by sex between men

The global monkeypox epidemic is primarily caused by sex between men, according to the first major peer-reviewed paper to analyze multiple cases of the virus.

The outbreak, which epidemiologists initially believe began when gay and bisexual men in Europe congregated in the middle of spring, has soared to nearly 16,000 cases worldwide, alarming such experts.

Infectious disease specialists are now developing an increasingly accurate understanding of the dominant routes of monkeypox transmission, as well as the typical course of the disease.

“These data clearly show that infections occur almost exclusively in men who have sex with men,” said Jennifer Nuzzo, an epidemiologist at Brown University, of the new study, published Thursday in the New England Journal. Medicine. “And the clinical presentation of these infections suggests that the spread of the virus in this population may be sexually transmitted rather than physical contact.”

“This large, multi-country study provides a comprehensive set of clinical and demographic data on monkeypox occurring outside of endemic areas,” said Nuzzo, who was not involved in the study.

During this outbreak, no one died of monkeypox outside of Africa. And for many people, the condition is relatively mild and resolves on its own within a few weeks without the need for medical intervention. However, a new paper suggests that monkeypox can cause illness so severe that a significant proportion of people infected with the virus require hospitalization for treatment.

“We’ve seen patients with rectal pain that gets worse every time they go to the bathroom, genital pain every time they urinate, and throat pain every time they swallow,” said Dr. Jason Zucker, an infectious disease specialist at Columbia University’s Department of Medicine.

Confirmed cases of monkeypox in the United States have risen sharply in recent weeks, reaching 2,593 as of Thursday. With infectious disease experts worried about the virus becomes endemic In the US and around the world, the Biden administration has been criticized by activists and the public health community for its failure to act quickly enough to contain the outbreak.

The recent spike in monkeypox diagnoses in the U.S. has been driven in part by increased testing, particularly after the Centers for Disease Control and Prevention brought five commercial testing companies on board in the past two weeks.

Public health experts also suspect that large LGBTQ Pride gatherings in June may have fueled the spread of the virus. And given the incubation period of the infection — the new paper puts it at seven days, three to 20 days — the nation may now see the results of intercourse in late June and early July.

For the new study, a consortium of multiple researchers pooled data on 528 cases of monkeypox from 43 sites in 16 countries between April 27 and June 24. These cases were 84 (16%) in America and 444 (84%) in Europe, Israel and Australia.

All cases were among men, including one transgender person, 98% of whom identified as gay or bisexual. This stark demographic finding is consistent with epidemic data from around the world, such as a recent British Health Agency report showing that 97% of 699 cases of monkeypox were gay, bisexual or other men who have sex with men. Out of 639 confirmed cases in the US epicenter New York City as of July 19, only one woman has been diagnosed with the virus.

According to the European Center for Disease Prevention and Control, the risk of monkeypox to the general public, in particular those who do not have sex with multiple partners, is “very low”. in it meeting soon, Dr. Agam Rao, a medical officer in the CDC’s Division of Highly Infectious Pathogens and Pathology, used the same words to describe the risk to the general public.

The average age of men in the new global study was 38 and ranged from 18 to 68. Three-quarters were white, and 41% had HIV.

Although some public health officials, including CDC officials, warned the public about the risk of monkeypox transmission, three of the 528 cases, or 0.6%, were believed to have been acquired this way. And only four, or 0.8%, were believed to have been infected through non-sexual contact.

According to the authors of the study, 95% of diseases can be transmitted through sexual contact. Moreover, their paper provides strong new evidence that anal sex itself, although not necessarily ejaculation, is a major source of transmission.

“A strong possibility of sexual transmission is confirmed by primary genital, anal, and oral mucosal lesions, which may represent the site of inoculation,” the study authors wrote.

“The finding that 95% of cases may be sexually transmitted may explain why this epidemic is primarily caused by intimate contact and why it has so far been limited to the dense social networks of men who have sex with men,” he said. Dr. Jay K. Varma, an infectious disease expert at Weill Cornell Medicine.

People wait in line for a monkey vaccine (Kena Betancourt/AFP via Getty Images)

In addition to the habit seen in monkeypox in 11 African countries, where the virus has been endemic since it was first discovered in humans in 1970, people with monkeypox often develop anorectal or genital ulcers during these outbreaks. .

Almost three-quarters of the men in the new study were affected in those areas.

“Inhalation droplets or sprays don’t seem to have been an important mechanism of transmission, because if they were, you should have seen more cases among cisgender women. We don’t have it yet,” said the doctor. Celine Gounder is a senior public health researcher and editor for Kaiser Health News. “Also, we haven’t seen any evidence that monkeypox is transmitted through, say, hugging. So it seems to require a really close, intimate connection.”

The World Health Organization recently reported that the monkeypox epidemic “primarily affects men who have sex with men who report having had sex with new or multiple partners recently.” The CDC recommends the Jynneos vaccine for men who report having more than four male sexual partners in the past 14 days.

A new document supports these characteristics of the epidemic. This includes the finding that nearly three-quarters of men with a sexual history reported an average number of sexual partners in the past three months of five, and a quarter of men had 15 or more.

One in five men reported using drugs during sex in the past month, and one in three reported having sex at a sex venue. 29 percent of those tested had a sexually transmitted infection or STD.

Public health experts warn that the symptoms of monkeypox are often confused with STDs.

A new article addresses the question of whether monkeypox can be sexually transmitted. Of the 32 men’s semen analyzed, 29 samples contained viral DNA. Previous studies have come to the same conclusion.

The researchers note that these findings do not confirm sperm transmission. More research is needed, they say.

Some health authorities, including the UK, have advised men who have recovered from monkeypox to wear condoms during sex for eight weeks as a precaution in case the virus remains in the testicles.

Condom use among gay and bisexual men has steadily declined since HIV became a curable infection in 1996. In the last decade, the advent of HIV prevention pills and scientific evidence that HIV treatment can prevent HIV transmission has accelerated this decline. In a CDC survey published in 2017, nearly three-quarters of gay and bisexual respondents reported having sex without a condom in the previous 12 months.

Based on the new paper, Gounder said, “If you’re going to avoid getting monkeypox, and based on what we know about how monkeypox is transmitted, condoms are very effective at preventing most or most of the infections we’re going to get now, and these are the worst cases.” is particularly effective in prevention.

Monkey pox usually causes flu-like symptoms before a rash appears, followed by sores on the skin. In the new paper’s cohort, these early symptoms often included fever, fatigue, muscle aches and headaches. Thirteen percent of men were hospitalized, mostly because of severe pain, particularly anorectal disease.

Even after accounting for these hospitalizations, the study authors said the health outcomes for the men in the study were “reassuring,” noting the majority of serious health complications.

Having HIV was not associated with any differences in monkeypox health outcomes. Almost all HIV-positive men were successfully treated for the virus because their immune systems were healthy.

Dr. Chloe Orkin, an infectious disease expert at Queen Mary University of London and the study’s lead author, joined her colleagues in calling for more awareness among health workers about the manifestations of monkeypox.

Pointing to the many images published in the paper of how the virus can appear in various parts of the body, including the mouth and throat, he said: “Hopefully doctors in primary care and emergency departments will not see many cases. They will also be able to recognize many presentations and make a diagnosis.” will not send.”

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