The World Health Organization on Wednesday recommended that gay and bisexual men limit the number of sexual partners they have to protect themselves from monkeypox and help slow transmission of the rapidly spreading virus.
WHO expert on monkeypox Rosamund Lewis said that men who have sex with men are currently the group most at risk of infection. Around 99% of cases are in men, Lewis says, and at least 95% of those patients are men who have sex with men.
WHO chief Tedros Adhanom Ghebreyesus said it is critical for public health authorities to engage the communities of men who have sex with men to reduce transmission of the virus and care for those who are infected, while protecting human rights and combating stigma and discrimination.
“For men who have sex with men, for now, this includes reducing the number of sexual partners, reviewing sex with new partners, and sharing contact details with any new partners so that action can be taken if necessary,” Tedros said.
Tedros urged social media platforms, tech companies and news organizations to stand up to malicious information, which he warned would only intensify the outbreak.
“Stigma and discrimination can be as dangerous as any virus and can fuel an outbreak. As we saw with the example of misinformation about Covid-19, this information can quickly spread on the Internet,” the WHO chief said.
According to the WHO, over 18,000 cases of monkeypox have now been reported in 78 countries. About 10% of monkeypox patients were hospitalized to treat the pain caused by the disease. Five deaths have been reported in Africa, according to the WHO.
The WHO declared a global health emergency in response to the outbreak over the weekend as cases rapidly increased. The current outbreak is very unusual because the virus is spreading widely in Europe and North America, where the virus does not normally occur. Historically, monkeypox spread in small numbers in remote areas of West and Central Africa, where the virus was carried by rodents and other animals.
Europe is now the epicenter of the global outbreak, with more than 70% of monkeypox cases reported. 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 the WHO and CDC.
More than 3,500 cases of monkeypox have been reported in the United States in 46 states, Washington, and Puerto Rico, according to the Centers for Disease Control and Prevention. The United States has the second highest number of monkeypox cases in the world after Spain.
WHO and CDC scientists have said that monkeypox is mainly spread through skin-to-skin contact during sex. Lewis said there would be an opportunity for the virus to spread more widely if people didn’t take precautions to limit the number of sexual partners and anonymous sex.
“If there is no intervention in circumstances where there is a lot of skin-to-skin contact on a regular basis, perhaps in the context of multiple partnerships or contact with anonymous partners, then it will be a no-intervention circumstance in which the virus can spread more easily,” Lewis said.
In the past, people infected with monkeypox have transmitted the virus to less than one person on average, so previous outbreaks have not spread as widely. But Lewis said a person with monkeypox may be able to transmit the virus to more people now because global immunity has weakened as smallpox vaccination has become much less common. Monkeypox is in the same family as smallpox, although it causes milder disease.
Experts have not been able to conclude whether monkeypox represents a new type of sexually transmitted infection, although it is clearly transmitted through sexual intercourse, according to Andy Seal, a WHO adviser specializing in STIs. It’s also unclear whether condoms will help reduce the risk of infection because monkeypox spreads through close physical contact, similar to herpes, Seal said.
“The critical part is really focused on the close, intimate personal contact, the continuous contact that happens during sex, as a key mode of transmission,” Seal said. Scientists in Spain and Italy have found monkeypox DNA in patients’ semen, though it’s not clear if the virus is actually spread that way.
While monkeypox is primarily spread through sex, anyone can contract the virus through close physical contact. This includes, for example, family hugs and kisses, as well as shared towels or contaminated bedding. There have been cases of women and children becoming infected with the virus during the current outbreak, although transmission in the wider community appears to be low at this time.
Monkeypox can also be spread through the air when infected people have lesions in their mouths, although this requires prolonged face-to-face contact. The outbreak can still be contained if people limit the risk of infection now, Lewis said.
“It is very important that anyone who has had monkeypox isolate to protect everyone who lives in their home or anyone they may come into contact with,” Lewis said. “Home transmission is how it was first discovered, and under some circumstances, household transmission may begin.”
Most people who contract monkeypox recover in two to four weeks, according to the US CDC. But the virus causes a rash that can be very painful. In the past, monkeypox began with flu-like symptoms and then progressed to a rash that could spread throughout the body.
But the symptoms of monkeypox in the current outbreak were unusual. Some people develop a rash first, while others don’t have any flu-like symptoms at all. Many people develop a localized rash on the genitals or anus.