Peer-Reviewed Study Finds Monkeypox Primarily Transmitted Sexually by Men

Peer-Reviewed Study Finds Monkeypox Primarily Transmitted Sexually by Men
A section of skin tissue, harvested from a lesion on the skin of a monkey, that had been infected with monkeypox virus, is seen at 50X magnification on day four of rash development in 1968. (CDC/Handout via Reuters)
Caden Pearson

The first major peer-reviewed study of monkeypox infections has found that the virus is primarily being transmitted through the sexual activity of gay and bisexual men in the United States and around the world.

The Journal of New England Medicine on Thursday published a study that looked at monkeypox infection across 16 countries between April and June, when cases began to emerge in countries outside of Africa.

The study reported on 528 infections diagnosed between April 27 and June 24, of which 98 percent were in gay or bisexual men with a median age of 38. Of these cases, 95 percent of the infections were suspected to have been transmitted through sexual activity—41 percent also had HIV.

Disease experts and officials from the U.S. Centers for Disease Control and Prevention (CDC) don't consider monkeypox a sexually transmitted infection but have always said it could be transmitted through intimate contact, such as sex. It can also be spread by close contact and even infected clothing and bedding.

Until this year, monkeypox virus infection in humans has been rare outside of Africa, where it is endemic but mostly spread from animals. But there are now more than 16,000 cases worldwide in countries that mostly have not historically had monkeypox, according to the CDC.

Most of the cases appear to be in North America and Western Europe, where some of the first cases were linked to major LGBT events in Spain and Belgium, considered ground zero for facilitating transmission of the virus.

The leading theory among disease experts is that the monkeypox virus was sexually transmitted at those events.

An uptick in recent U.S. cases suggests transmission occurred at the tail end of Pride Month in late June and early July, based on the study finding that incubation is between three and 20 days (usually seven days).

Former Trump Health Officials Blame CDC

CDC officials were hesitant to recommend canceling marquee U.S. LGBT events, similar to the super spreading events in Europe that occurred the month prior.

LGBT event organizers were also treading carefully in the spring, wanting to avoid stigmatizing the LGBT community. U.S. health officials opted instead to boost targeted messaging to warn gay and bisexual men, who were deemed most at risk.

But officials should have done more, says Dr. Paul Alexander, a former Trump administration health official and researcher.

"All this needed was leadership saying no skin to skin contact, no anal sex, no sex, none for a few weeks and we would have helped this high risk group, but no, it’s political games and now the low-risk general heterosexual population is at risk especially from bisexual males," Alexander wrote in a blog post.

The blog post also included a Twitter thread by a gay U.S. man recounting in graphic detail his experience with contracting monkeypox during an orgy in Palm Springs.

Alexander expressed concern that bisexual men could facilitate the spreading of the monkeypox virus outside of the LGBT community to heterosexuals. In fact, the CDC has said they know of eight cases in women and two new cases in children—one a toddler and the other an infant, BBC News reported.

"Heterosexuals could spread this if one partner is infected and there is rough abrasive sex that involves tearing of tissue," Alexander added.

"This is not about being ‘gay,’ the virus is transmitted in bodily fluids and infected pustules and lesions in the infected person, through any tears on the skin or tissue e.g. rectal micro lesions etc," he continued. "If heterosexuals engage in anal sex and one is infected with monkeypox or another [sexually transmitted disease], the other will get infected if there is tissue tearing."

Although monkeypox infection generally clears up within a couple of weeks without the need for medical treatment, it has hospitalized some who experience severe anorectal pain, severe sore throats, and acute kidney injury.

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