It's a FAGGOT SPREAD DISEASE! Nothing will change that.
The global monkeypox outbreak is now a public health emergency
both in the US and globally, with more than 38,000 cases
currently reported across 93 countries as of August 17. Health
authorities worldwide are still struggling to get it in check:
According to the World Health Organization, cases increased by
more than 19 percent in the past week.
Theyre also struggling to figure out how to talk about what it
takes to transmit the infection. During an Infectious Disease
Society of America press briefing last week, the director of a
large LGBTQ health clinic delivered whats become a standard
talking point among health authorities: Skin-to-skin contact is
causing transmission of this virus in the context of sex, he
said.
He wasnt wrong, per se: The virus does spread most readily when
one persons skin is exposed to anothers open sores. But many
officials seem hesitant to talk in detail about the role of
penetrative sex between men that is, body part-in-orifice sex,
like anal and oral sex in the current outbreak.
Its part of a larger trend of health officials across the
country being mealy-mouthed when it comes to clear risk
communication. A story in the Washington Post referenced one
state health department official who argued that urging people
to have less sex unfairly places the onus on individuals to end
the outbreak, which seems to minimize the options people have
for reducing their infection risk. The official also argued that
urging people to have less sex distracts from other potential
sources of transmission, such as dancing in packed clubs.
Similarly, a New York City health department epidemiologist
wrote of his employers unwillingness to publicly recommend
sexual behavior changes that we seem paralyzed by the fear of
stigmatizing this disease.
Many health officials reluctance to speak frankly might be
coming from a well-intentioned place. As other journalists have
noted, some of the vague-speak may be an effort to avoid giving
ammunition to people whod use gay and queer mens sexual
practices to demonize same-sex sexual contact and justify
discrimination.
But unclear communication wont stop this outbreak: People cant
take action to keep themselves safe from infections if they
dont know how theyre spread, and which behaviors appear most
risky according to the latest data.
Gay and bisexual men and the health organizations run by them,
for them have been at the forefront of offering clear
communication about monkeypox risk reduction. Its time for
public health officials and the medical leadership who serve the
general public to do the same.
Although clinicians and scientists in sexual health are engaged
in a heated debate over whether monkeypox is a sexually
transmitted infection, this is a semantic argument, and one
thats ultimately less important than helping people keep
themselves safe. Making clear statements about the sexual
behaviors most likely to spread monkeypox can help people across
the spectrum of anatomy and sexual orientation understand how to
protect themselves.
Lets break it down.
Connecting the spots: Why scientists think sex is spreading
monkeypox
As more data about this outbreak comes in, scientists are
getting a clearer picture about how monkeypox infections start.
Scientists theorize that in people infected with monkeypox who
develop a rash as the vast majority of them do the first
spots turn up at the body site where the virus first made its
way in.
This inoculation site theory is in part based on the way
monkeypox infections have historically played out: For many
infected people, the first symptom is a rash localized to one
part of the skin or mucous membranes, which are the moist
linings of openings like mouths, noses, vaginas, and anuses.
Several days afterward, these rashes are frequently followed by
fever and aches. After that, a more widespread rash affecting
other skin surfaces often develops. In both the first and third
phases, the lesions of the rash are chock-full of virus, said
Donald Alcendor, a virologist at Meharry Medical College.
Most experts believe the inoculation-site theory to be true,
among them Chloe Orkin, an infectious disease doctor at Queen
Mary University of London whose research group conducted a study
describing 528 monkeypox cases in the United Kingdom. We and
others have speculated that the main site of the first lesion is
likely to represent the point of inoculation, Orkin wrote in an
email.
A caveat: Some people involved in the current outbreak have had
somewhat different experiences with monkeypox than the
inoculation-site theory would predict. In one study, a third of
cases did not report fever, and in some cases, the rash present
in the third phase of infection has been pretty mild. These
differences in the usual pattern of the disease make it harder
to pinpoint the viruss entry point, and its not clear whats
causing them.
However, cases in which the viruss entry point can be
identified paint an emerging picture: People are first getting
infected during sex involving penises, mouths, and butts.
Most current monkeypox transmission is currently happening
during sex
Before 2019, body parts involved in sex were not front and
center in reports of monkeypox outbreaks. Then a publication
describing a Nigerian outbreak noted large numbers of patients
turning up with genital rashes. That study didnt offer
specifics of the exact location of genital rashes but more
recent studies have.
These studies get specific: They suggest that contact involving
mens mouths, penises, and anuses is responsible for the lions
share of monkeypox spread right now.
For example, in a recent Spanish study of 181 monkeypox cases,
nearly all of whom were men, 55 percent of patients had genital
lesions, 25 percent had lesions in or near their mouths, and 36
percent of patients had rashes around the anal area. (Many
people in the study had lesions in more than one area, and were
counted in more than one category.)
Orkins similar study of cases in the UK found 73 percent had a
rash in the anogenital area, which includes both the anus and
the genitals. A US study found that 25 percent of patients had
lesions near their mouths. Across all three of these studies, 14
to 25 percent of patients have had proctitis, an extremely
painful condition in which the tissues of the rectum the part
of the large intestine beyond the anus get irritated and
inflamed.
Reports of symptoms involving the anus, the mouth, and other
mucous membranes have been particularly surprising, as they had
rarely been reported with monkeypox infections during past
outbreaks, said John Brooks, chief medical officer of HIV
prevention division and the monkeypox response at the Centers
for Disease Control and Prevention (CDC). This real
concentration in the anogenital region, which is where sexual
contact occurs, and mucosal lesions this is unusual, he said.
Why are scientists so suspicious these rashes represent the
places on the body where patients first became infected,
implying sexual transmission? After all, the currently
circulating monkeypox virus is genetically distinct from
previous strains. Isnt it possible one of its new features is a
predisposition to causing genital rashes after first exposure
elsewhere on the body?
Theyre suspicious because of how commonly those rashes follow
sexual activity involving the place where they appear. In the
Spanish study, for example, 91 percent of people with proctitis
due to the virus said they had been on the receiving end of anal
sex, and 95 percent of people with symptoms in the mouth or
throat said theyd given oral sex.
Again, what this suggests is that contact during anal and oral
sex potentially including rimming, or oral-anal sex is
responsible for the majority of monkeypox spread right now.
Sex can spread infections fast and more sex can spread
infections faster
The rapid spread of monkeypox seen during this outbreak is
unusual for this virus. For example, Nigeria the country with
the highest burden of this monkeypox strain prior to the current
outbreak reported 915 suspected and confirmed cases in total
between September 2017 and mid-June of this year. As many global
cases are now recorded each day.
But for a sexually transmitted infection within interconnected
sexual networks, where lots of people have sex with the same
people, its not particularly surprising. The more sexual
partners one has, the higher the risk of exposure and
transmission, wrote Orkin. Cases in her groups study reported
a median of five sexual partners in the preceding three months.
Again, this suggests that the current spread is not due to any
old skin-to-skin contact, but due to sexual contact happening
between people who have multiple sex partners.
Its also not particularly surprising to see a lot of the spread
happening at events and venues where sex is happening on site.
At many of these venues, its not uncommon to have multiple
partners in the course of hours at one event. And while overall,
a minority of men who have sex with men use drugs during sex,
that practice often called chemsex is more common at sex-
on-site venues, and often leads to having more sexual partners.
A third of people with monkeypox in the UK study said theyd
gone to a sex-on-site venue in the past month, and the same
proportion of cases in the Spanish study reported using
recreational drugs during sex. So its not a stretch to
speculate that drug use is a contributing risk factor here.
Even if attending these events is something only a small
percentage of the worlds men who have sex with men do, its
something that monkeypox cases have disproportionately reported
doing, suggesting its an important risk factor. So should these
sex events be canceled? Theres some disagreement among public
health experts about the benefits of doing so, with some arguing
its unhelpful at best and stigmatizing at worst to tell people
especially gay and bisexual people not to have sex.
That said, people who want to avoid monkeypox will find it
easier to do so if they avoid group-sex situations, at least
until other precautionary measures are in place.
We hate to say it, but it might be time to hang up the group
sex and saunas until we all get shots one and two of the
vaccine, wrote the authors of a mens safer sex guidance
document, all of them public health practitioners. Both the
World Health Organization and the CDC have recommended that
people temporarily reduce their number of sexual partners.
Few women are getting monkeypox right now but that doesnt
mean they cant or wont
Most monkeypox transmission in the current outbreak has happened
between men but women can still catch the virus.
Even though most men who have sex with other men dont also have
sex with people of other genders, a subsegment does: 11 of the
men in the Spanish study reported vaginal intercourse, and six
of the 181 patients in that study were heterosexual women.
Although the study didnt report the number of female cases who
gave oral sex to men, theres no reason that could not also
result in monkeypox transmission from a man to a woman.
Although most of the transmission recorded so far has been
between men, its probably not because the virus is better at
infecting men. More likely, its a feature of how rarely gay
mens sexual networks include women.
I would just be very careful about characterizing this as
something unique to the kind of sex that men who have sex with
men have, said Brooks. Early in the HIV crisis, he explained,
people thought that virus wouldnt make many inroads with
heterosexual people in the way it did with gay men. But in sub-
Saharan Africa, HIV is now largely a disease that affects
heterosexual people, he said.
Philip Chan, an infectious disease doctor at Brown Universitys
public health school who is medical director at the largest STI
clinic in Rhode Island, agrees. Hes heard hypotheses that
straight people dont have lots of overlapping sexual
partnerships the way gay and queer men and their sexual networks
do, making heterosexual sex less likely to spread the disease
broadly. Im not sure thats entirely true, he said.
Although monkeypox has not been transmitted at the same speed
outside gay and queer mens sexual networks as it has within
them, that doesnt mean it couldnt happen. If the virus is
introduced into dense and active heterosexual networks, like
those involving commercial sex workers or swingers, I think it
would spread quickly, wrote Orkin.
Using condoms and temporarily changing sexual behaviors
could help prevent some of monkeypoxs worst symptoms
Many monkeypox studies now being published include photographs
of the characteristic lesions in the many places where theyre
appearing. Those photos often depict rashes on mucous membranes
(inside mouths, throats, or anuses) but many also show rashes
around the openings to those spaces.
In other words, in many people with monkeypox rashes on their
penises, the lesions spread well beyond the parts of the
genitals that would be covered by a condom. Its reasonable to
imagine a barrier that only covers the shaft would do very
little to prevent transmission from a person with a rash around
their penis or around their anus.
Indeed, condoms havent been front and center among monkeypox
prevention recommendations: Although the CDCs guidance does
mention condoms, many other messaging sources dont.
But leaving condoms out of the conversation might mean
neglecting an important strategy for preventing proctitis, one
of the most severe monkeypox outcomes. If the inoculation-site
theory is correct, this condition which involves inflammation
of the deep tissues of the anus is more likely to happen when
sores on a penis (or any virus in semen) have direct contact
with those tissues.
Using that logic, putting a condom on a penis before anal sex
theoretically makes that contact and therefore proctitis
less likely, even if no scientific studies have supported that
theory yet. (Rectal tissue is particularly fragile and the anus
lacks natural lubrication, making the area especially vulnerable
to tears and abrasions that create entry points for certain
infections.)
During penis-in-vagina sex, condoms could also theoretically
reduce the risk that an infected penis would cause lesions
within the vagina.
In a press conference on August 11, Mary Foote, an infectious
disease physician who directs emergency preparedness at the New
York City health department, said there probably is a role for
condoms in preventing some disease: In a completely data-free
zone, she said, I would say that using condoms certainly may
help reduce the worst of it.
Foote also noted that a significant proportion of newly
diagnosed monkeypox cases are also being diagnosed with other
sexually transmitted infections like syphilis, chlamydia, and
gonorrhea nearly a third of those described in the UK study,
and 17 percent of those in the Spanish study. At a minimum,
condom use could help prevent the transmission of those
infections. Monkeypox alone is bad enough. Monkeypox plus an STI
likely means more symptoms and definitely means more
antibiotics.
In addition to getting vaccinated, people can also reduce their
risk by avoiding close sexual contact like kissing and oral,
anal, and vaginal sex, especially with new sexual partners,
wrote Debby Herbenick, a sexual health researcher and professor
at Indiana Universitys public health school, in an email.
Nobody wants to be telling people not to have sex right now.
Its difficult timing, coming at a point in the pandemic where
many people are vaccinated, boosted, and wanting to reconnect
with others, said Herbenick.
But she emphasized that changes in sexual practices wouldnt
have to be a new normal. This is not about changing behavior
forever its for some limited period of time, she said.
<https://www.vox.com/science-and-health/2022/8/17/23298665/sex-
monkeypox-sti-sexually-transmitted-spread-anal-oral-vaginal-
condoms>