NEW YORK (AP) – For most of the six decades that monkeypox has been affecting humans, it was not known as a sexually transmitted disease. Now that has changed.
The current outbreak is the largest of the virus and has been designated as a global emergency. So far, officials say, all the evidence points to the disease spreading mainly through networks of men who have sex with men.
“It’s clear that it’s spreading as an STD[sexually transmitted infection],” said Dr. Tom Inglesby, director of the Johns Hopkins Health Center.
To protect those at risk, public health authorities are focusing their attention on those people and attacking them based on the current behavior of the virus.
The head of the World Health Organization issued advice to men on Wednesday Monkey sufferers should consider reducing their sexual partners “for now”.
But this is a complex epidemic, its distribution and which population groups are most likely to be affected. There is debate over whether monkeypox should be called a sexually transmitted disease, with some critics complaining that the term creates stigma and can be used to stigmatize gay and bisexual men.
Monkey pox can also be spread non-sexually, and using condoms or other standard precautions isn’t enough to stop STDs, Inglesby and other experts say.
Here’s what we know.
WHAT MAKES SOMETHING SAFE?
A sexually transmitted disease is basically defined as a disease that is transmitted through sexual intercourse. But some STIs can be spread in other ways. HIV is transmitted through shared needles. Syphilis is spread through kissing. A common, parasitic sexually transmitted infection called trichomoniasis has been found to be spread by sharing moist, wet items such as sponges or towels.
Monkeypox doesn’t usually spread easily between people, and experts are still trying to understand exactly how it spreads from person to person. In Africa, where small epidemics have been reported for many years, people have become infected through the bites of rodents or small animals.
But in May, cases began to appear in Europe, the United States and elsewhere showing a clear pattern of infection through intimate contact with an infected person, along with many other sexually transmitted diseases.
Public health workers who respond to outbreaks play a major role in how they develop. Much of the work on monkeypox was done by professionals who worked in sexual health clinics or specialized in STIs.
Indeed, the US government’s response should be led by people with that expertise, said David 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 dealing with a variety of epidemics and diseases that affect communities … we see monkeypox as it affects us today,” Harvey said.
WHO’S RUNNING THE MONKEY LINE?
World Health Organization officials said last week that 99% of cases of monkeypox outside Africa were in men, and 98% of those cases were men who had sex with men. Experts suspect that the epidemic of monkeypox in Europe and North America was sparked by sex in two scandals 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, it also appeared in other groups, including at least 13 people who were female at birth and had at least two children..
Last week, the New England Journal of Medicine published a study Hundreds of monkeys infected in 16 countries. According to doctors, 95% of infectious diseases were transmitted through sexual intercourse. The researchers noted that sexual transmission cannot be confirmed.
According to the researchers, this idea is based on the fact that most men have lesions in the genital or anal areas or in the mouth – sexual areas.
WHY IS THERE A DISCUSSION ABOUT CALLING IT A STD?
Although there is broad agreement among health care professionals that monkeypox is sexually transmitted, some experts debate whether it should be called an STD. They worry that the term is unfairly stigmatized and that it could undermine efforts to identify infections and slow the epidemic.
When the 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 threat to them, says epidemiologist Jason Farley of Jones. 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 infection to other groups. Farley said.
“We don’t learn anything from our history,” said Farley, who is gay.
The WHO recommendation to limit sexual partners of at-risk men is sound public health advice, he said. But it also “reinforces the message that this is a gay disease,” he said.
“It’s a public health approach that focuses on current epidemiology versus the likelihood of new cases occurring in the general community,” he said.
“Monkey pox is not a sexually transmitted infection,” he said. “It’s a sexually transmitted infection.”
WHAT IS KNOWN ABOUT THE PASS?
Some researchers have found evidence of the monkeypox virus in the seeds. To read In Spain, monkeypox virus DNA has been found 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 was actually transmitted through the seed.
Sorting this out could have implications for understanding not only how men spread the infection, but also how long they may be contagious. Evidence of other viruses, such as Ebola and Zika, has been found in some men’s testicles months after they were thought to be fully recovered.
Meanwhile, scientists believe the main route of transmission during the current outbreak was skin-to-skin contact during sex with a person with symptoms. In this respect, it is similar to herpes, some experts have pointed out.
The virus can also be transmitted through saliva and respiratory droplets through prolonged, face-to-face contact, such as kissing and hugging – which can also be spread outside of sex.
Christopher Mores, a professor of global health at George Washington University, said researchers are studying how often and under what circumstances such outbreaks might occur.
“We would be doing ourselves a disservice to try to remove anything from the realm of possibility at this point,” he said.
Officials also say people can also get infected by touching the rash or body fluids of an infected person, such as towels or sheets. This is thought to explain the infections in children in the US.
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 currently believe that those most at risk are gay or bisexual men who have sex with multiple partners. This understanding has prioritized much of the work to stop the epidemic, including the delivery of vaccines and treatments.
The government is sending monkeypox vaccine, but supply is limited. So far, it has been recommended as a follow-up treatment to people who have had multiple sexual partners in the past two weeks in areas where monkeypox has been reported.
The vaccine is new, and officials are trying to gather data on how well it works.
Associated Press writer Jamie Kiten in Geneva contributed to this report.
The Associated Press Health and Science Division is supported by the Howard Hughes Medical Institute Division of Science Education. AP is solely responsible for all content.