WHO recommends gay, bisexual men limit sexual partners to reduce spread

People line up for Test Positive Aware Network nonprofit clinic to receive monkeypox vaccine in Chicago, Illinois, July 25, 2022

Eric Cox | Reuters

The World Health Organization recommended on Wednesday that gay and bisexual men limit their number of sexual partners to protect themselves from monkeypox and slow the transmission of the rapidly spreading virus.

WHO monkeypox expert Rosamund Lewis said men who have sex with men are currently the group most at risk of infection. About 99% of cases are among men, and at least 95% of those patients are men who have sex with men, Lewis said.

WHO chief Tedros Adhanom Ghebreyesus said it is critical for public health authorities to engage communities of men who have sex with men to reduce the transmission of the virus and care for those infected, while protecting human rights through stigma and discrimination to fight.

“For men who have sex with men, for now, this includes reducing the number of sexual partners, reconsidering sex with new partners, and exchanging contact information with new partners to allow for follow-up if necessary,” Tedros said.

Tedros called on social media platforms, tech companies and news organizations to curb harmful information, which he warned will only fuel the outbreak.

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“The stigma and discrimination can be as dangerous as any other virus and fuel the outbreak. As we’ve seen with disinformation about Covid-19, and this information can spread quickly online,” the WHO chief said.

More than 18,000 cases of monkeypox have now been reported in 78 countries, according to WHO data. About 10% of monkey pox patients are hospitalized to manage the pain of the disease. Five deaths have been reported in Africa, according to WHO.

The WHO declared a global health emergency this weekend in response to the outbreak as the number of cases has risen rapidly. The current outbreak is highly unusual as the virus is spreading widely in Europe and North America, where the virus is not normally found. Historically, monkeypox spread at low levels in remote parts of West and Central Africa, where rodents and other animals carried the virus.

Europe is currently the epicenter of the global outbreak, reporting more than 70% of monkey pox cases. About 25% of monkeypox cases have been reported in the Americas, with the US being the center of the outbreak in the Western Hemisphere, according to data from the WHO and CDC.

The US has reported more than 3,500 cases of monkeypox in 46 states, Washington DC and Puerto Rico, according to the Centers for Disease Control and Prevention. The US has the second highest number of monkey pox cases in the world after Spain.

Monkeypox spreads primarily through skin-to-skin contact during sex, WHO and CDC scientists have said. Lewis said the virus has a chance to spread more widely if people don’t take precautions by limiting the number of sex partners and anonymous sexual contact.

“If no intervention is made in a circumstance where there is a lot of skin-to-skin contact on a regular basis, perhaps in the context of multiple collaborations or contact with anonymous partners, that would be a circumstance, without intervention, where the virus can spread more easily, said Lewis.

In the past, people infected with monkey pox passed the virus to less than one other person on average, which is why previous outbreaks have not spread as widely. But Lewis said a person with monkeypox may now be able to pass the virus to more people as global immunity has declined as smallpox vaccination is much less common. Monkeypox belongs to the same family as smallpox, although it causes a milder disease.

Experts have not been able to conclude whether monkeypox represents a new type of sexually transmitted infection, although it is clearly transmissible during sex, according to Andy Seale, a WHO adviser who specializes in STIs. It’s also unclear whether condoms would help reduce the risk of infection, because monkeypox spreads through close physical contact, similar to herpes, Seale said.

“The crucial piece really focuses on close, intimate personal contact, prolonged contact that takes place during sex as the main mode of transmission,” Seale said. Scientists in Spain and Italy have detected monkeypox DNA in patients’ semen samples, although it’s unclear whether the virus also spreads that way.

Although monkeypox is mainly spread during sex, anyone can contract the virus through close physical contact. Think of cuddling and kissing within a family, but also shared towels or bedding that is contaminated. There have been cases of women and children contracting the virus during the current outbreak, although transmission appears to be low in the wider community at the moment.

Monkeypox can also spread through respiratory droplets when infected individuals have lesions in their mouth, although this requires prolonged face-to-face interaction. The outbreak could still be contained if people limit their risk of exposure now, Lewis said.

“It’s very important for anyone who has monkeypox to isolate so they can protect someone else in their household or anyone else they may come in contact with,” Lewis said. “Household transfer is how this was first discovered, and household transfer can start to occur in some circumstances.”

Most people who get monkey pox recover within two to four weeks, according to the US CDC. But the virus causes a rash that can be very painful. In the past, monkeypox started with symptoms similar to the flu and then developed into a rash that can spread across the body.

But the monkeypox symptoms in the current outbreak were unusual. Some people develop a rash first, while others have a rash without any flu-like symptoms. Many people develop a localized rash on their genitals or anus.

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