Monkeypox and gay and bisexual men: Fact sheet

What is monkeypox?

Monkeypox is a rare disease that is caused by infection with monkeypox virus.

The virus is a pox virus that was first discovered in monkeys in 1958, hence the

name. It is believed that the virus naturally lives and reproduces in rodents in

central and western Africa. The first human case of monkeypox was identified in

the Democratic Republic of Congo in 1970, and it has also been found in other

central and western African countries. Past outbreaks have typically involved a

relatively small number of cases among residents of rural hunting villages in the

African rainforest. Over the past half century there have been several outbreaks

of monkeypox in other parts of the world, including an

outbreak in the U.S. in

2003 related to Gambian giant rats imported by an exotic pet dealer. For more

information see the Centers for Disease Control and Prevention (CDC) website

section on monkeypox.

Why is monkeypox suddenly in the news?

In May 2022 about 200 verified and suspected cases of monkeypox

were reported

in Europe, North America, Israel, and Australia. All but one case occurred among

men, and many were among gay and bisexual men. No one is known to have died

in the current outbreak.

How is monkeypox spread?

According to the Centers for Disease Control and Prevention:

Monkeypox spreads between people primarily through direct contact with

infectious sores, scabs, or body fluids. It also can be spread by respiratory

secretions during prolonged, face-to-face contact. Monkeypox can spread

during intimate contact between people, including during sex, as well as

activities like kissing, cuddling, or touching parts of the body with

monkeypox sores. At this time, it is not known if monkeypox can spread

through semen or vaginal fluids.

While monkeypox is not a traditional sexually transmitted infection, it appears

that it can be transmitted through prolonged physical contact, such as through

sexual intimacy and even prolonged kissing (“making out”). Several individuals

diagnosed with monkeypox engaged in sex with new partners, so they may have

contracted monkeypox through sexual behavior.

What are the symptoms?

Symptoms include fever, headache, muscle aches, exhaustion, chills, and swollen

lymph nodes. Usually within 1-3 days an individual with monkeypox develops a

rash and then lesions, which progress through a number of phases before

bursting as pustules, scabbing, and falling off. The illness usually lasts 2-4 weeks.

The current outbreak is believed to be of the western African variant, which is

relatively milder than the central African version. For more information see the

CDC’s list of monkeypox symptoms.

How do I protect myself against monkeypox?

During the current outbreak, you may want to avoid large gatherings such as

raves and dance parties where you may have close body contact with others. In

the short-term you may also want to avoid physical intimacy with strangers

whose health status and recent travel history you are not familiar with. You may

want to ask new partners about whether they have any of the early symptoms of

monkeypox, such as fevers, swollen glands, body aches, or a rash. These

symptoms may be due to many other infections, but it will be good for those

partners to seek medical care before engaging in any sexual activity. It is probably

also a good idea to avoid sex clubs and saunas for the time being. But if you’re

going to them—or private sex parties—minimizing physical contact and partners

is a way to reduce your risk.

Emory University infectious disease specialist Dr. Boghuma Titanji emphasized the

risk of close contact in an article in Poz magazine

“Close contact is not only sexual contact,” said Boghuma Titanji, MD, PhD,

an infectious disease specialist at Emory University in Atlanta. “If you are at

a crowded concert, bar, or club, body to body with other people, that’s

close contact too. All forms of sexual contact are close contact. Infectious

pathogens flourish with the right timing and opportunity. That’s how

outbreaks occur.”

Individuals who are close contacts with someone who has been diagnosed with

monkeypox may benefit from smallpox vaccine up to two weeks after exposure. If

you are a close contact with someone diagnosed with monkeypox please contact

a health care provider immediately.

There is no evidence that condoms or pre-exposure prophylaxis (PrEP) for HIV

prevention are effective in protecting against monkeypox.

What should I do if I think I have monkeypox?

During a media briefing held Monday, May 23, CDC epidemiologist John Brooks,

MD, of the CDC’s Division of HIV/AIDS Prevention said that anyone with a new or

unexplained rash or other symptoms should see their healthcare provider and

raise the possibility that the rash may be a symptom of monkeypox. “Don’t

hesitate to advocate for your health and inform your doctor of your concerns if

you think you may have been exposed,” Brooks said. During the same briefing,

Capt. Jennifer McQuiston, DVM, MS, Deputy Director of the CDC’s Division of High

Consequence Pathogens and Pathology, said that most people typically recover

from monkeypox within four to six weeks. You can listen to the briefing in full

this link.

What does monkeypox have to do with gay and bisexual men and other MSM?

The current outbreak of monkeypox in Europe and North America appears to be

related to two raves held recently in Spain and Belgium

and attended primarily by

gay men, according to David Heymann, Professor of Infectious Diseases at the

London School of Hygiene and Tropical Medicine, and an advisor to the World

Health Organization. The virus was likely transmitted via sexual contact, Heymann

theorized. However, as sexual contact involves close physical contact,

distinguishing between the two in terms of contribution to transmission would be

difficult. The CDC subsequently

issued an alert during the May 23 media briefing

warning gay and bisexual men that the virus appears to be spreading in the

community globally.

Is monkeypox a gay disease?

No. Monkeypox appears to be spreading now among some sexual and social

networks of gay and bisexual men and other men who have sex with men (MSM).

However, there is no such thing as a gay disease. Viruses and bacteria can and do

infect anyone regardless of sexual orientation. It is also not a sexually transmitted

infection. Instead, it is spread through close contact, as previously described.

Anyone can get monkeypox, including heterosexual people, women, transgender

and nonbinary people, and others.

It is important not to stereotype gay and bisexual men and/or Africans as bearers

of disease. Gay and bisexual men and African immigrants already experience

significant stigma and prejudice and are vulnerable to discrimination and violence

victimization. Stigma about gay and bisexual people, including laws criminalizing

homosexuality and same-sex behavior which still exist in many countries, may

cause men who have sex with men to fear disclosing their same-sex behavior. This

may also make them reluctant to disclose that they are part of social and sexual

networks that are disproportionately affected by the current outbreak, making

prevention of the spread of monkeypox more difficult. The public health response

to this outbreak of monkeypox should not be allowed to exacerbate homophobia

and racism and the scapegoating of gay and bisexual men and African immigrants.

What about people living with HIV?

There are no known cases of monkeypox in people living with HIV. Since

immunosuppression may lead to more serious cases of monkeypox, it is

important that people with HIV be on effective antiretroviral therapy, so their

immune systems are able to fight back against the monkeypox virus.

Is treatment available?

According to the CDC web page on this topic, dated July 16, 2021:

For purposes of controlling a monkeypox outbreak in the United States,

smallpox vaccine, antivirals, and vaccinia immune globulin (VIG) can be

used.

Where can I learn more information?

As more information is made available by the CDC and Massachusetts DPH,

Fenway Health will help elevate this information on our website. You can also

check the CDC’s information about monkeypox and the state’s Department of

Public Health’s information about monkeypox.

Acknowledgements

Written by Sean Cahill, PhD, Director of Health Policy Research, The Fenway

Institute.

Reviewed by Kenneth Mayer, MD, Medical Research Director, Fenway Health, Co-

Director, The Fenway Institute, Professor of Medicine, Harvard Medical School,

Attending Physician, Infectious Disease Division, Beth Israel Deaconess Hospital;

Ami Multani, MD, Medical Director of Infectious Disease, Fenway Health; Gregg

Gonsalves, PhD, Associate Professor of Epidemiology, Yale School of Public

Health, codirector of the Global Health Justice Partnership; Brian Bakofen, DO,

Interim Medical Director, Fenway Health; Carl Sciortino, Executive Vice President

of External Relations, Fenway Health.