Considering that Monkeypox spreads through close physical contact, concerns have risen about sexual behaviour. And given the spread of Monkeypox in the US, many experts are wondering if this could lead to the emergence of a new sexually transmitted disease, though some health officials say the virus that causes pimple-like bumps might yet be contained before it gets firmly established. Experts don’t agree on the likely path of the disease, with some fearing that it is becoming so widespread that it is on the verge of becoming an entrenched STD — like gonorrhoea, herpes and HIV.
WHAT DO WE KNOW ABOUT MONKEYPOX AND SEX?
Monkeypox can spread through close contact of any kind, including through kissing, touching, oral and penetrative vaginal or anal sex with someone who is infectious. Anyone with new and unusual rashes or skin lesions should avoid sexual contact until they have had been checked for sexually transmitted infections (STIs) and Monkeypox. This disease does resemble other infectious diseases such as chickenpox, herpes and syphilis. This may explain why several of the cases in the current outbreak have been identified among people seeking care in sexual health clinics. Remember that the rash can also be found in places that can be hard to see, including the mouth, throat, genitals, vagina and anus/anal area.
While the Monkeypox virus has been found in semen, it is currently not known whether it can be spread through semen or vaginal fluids. People with Monkeypox are advised to use condoms for 12 weeks after they recover until more is known about levels of the virus and potential infectivity in semen during the period that follows recovery. Wearing a condom won’t protect you from catching Monkeypox, but it will help protect you and others from a range of other STIs.
When possible, exchange contact details with any new sexual partners, even those you were not planning to see again. This way, you can be notified if your partner develops any symptoms, or you can notify them if it happens to you. People with multiple sexual partners are encouraged to take steps to reduce their risk of being exposed to Monkeypox by avoiding close contact with anyone who has symptoms. Reducing your number of sexual partners will reduce your risk.
The virus does not only spread through sexual contact, but also through any form of close contact with someone who is infectious. Persons living in the same household are at higher risk. Anyone who has symptoms that could be Monkeypox should seek advice from a health worker immediately.
ARE MEN WHO HAVE SEX WITH OTHER MEN AT HIGHER RISK?
The risk of Monkeypox is not limited to people who are sexually active or men who have sex with men. Anyone who has close contact with someone who has symptoms is at risk.
Many of the cases that have been reported in this outbreak have been identified among men who have sex with men. Given that the virus is currently moving from person to person in these social networks, men who have sex with men may currently be at higher risk of being exposed if they have close contact with someone who is infectious.
One reason we are currently hearing more reports of cases in communities of men who have sex with men may be because of positive health-seeking behaviour in this population group. Monkeypox rashes can resemble some sexually transmitted diseases, including herpes and syphilis, which may partly explain why these cases are being picked up at sexual health clinics. As we learn more, we may identify more cases in the broader community. Engaging communities of gay, bisexual and other men who have sex with men to raise awareness is essential to protect those most at risk.
HOW CAN WE AVOID STIGMA RELATED TO SAME SEX BEHAVIOUR DURING THE OUTBREAK?
We have seen messages stigmatising certain groups of people around this outbreak. We want to make it very clear that this is not right. First, anyone who has close physical contact of any kind with someone who has Monkeypox is at risk, regardless of who they are, what they do, who they have sex with or any other factor. Second, stigmatising people because of an illness or a disease is unacceptable. Stigma is only likely to make things worse and stop us from ending this outbreak as fast as we can. We need to all pull together to support anyone who has been infected or who is helping to take care of people who are unwell. We know how to stop this disease, and how we can all protect ourselves and others. Stigma and discrimination are never okay. We are all in this together.
IS MY RISK OF DYING FROM MONKEYPOX HIGHER IF I AM LIVING WITH HIV?
If untreated, HIV can weaken your immune system. There is some evidence that being immunocompromised may increase your risk of becoming infected if you are exposed, and of having serious illness or dying from Monkeypox. However, more data is needed to understand this fully.
People with underlying immune deficiencies may be at risk of more serious illness from Monkeypox. People living with HIV, who know their status and have access to and properly use treatment, can reach the point of viral suppression. This means that their immune systems are less vulnerable to other infections than they would be without treatment. Many people in the current outbreak have been HIV positive, but there have been few severe cases, likely because their HIV infection was well-controlled. Studies are underway to better understand these questions.
People with multiple sexual partners, including people who are living with HIV, are encouraged to take steps to reduce their risk of being exposed to Monkeypox by avoiding close contact with anyone who has symptoms.
WHAT CAN I DO IF SEXUAL HEALTHCARE SERVICES ARE OVERWHELMED?
You can support your local health services by doing what you can to stay healthy, including practising safer sex. If online, video or phone services are available and appropriate for your questions or symptoms, using them can help reduce the pressure on in person services. Taking action to protect yourself and others against Monkeypox will help to reduce the number of cases, end this outbreak and will therefore reduce the burden on health services.
If you have symptoms that could be Monkeypox, it is important that you contact a healthcare provider for advice, testing and care, even if they are busy. Because Monkeypox spreads through close contact, take care to avoid exposing health workers to the virus – call ahead before your visit to warn them that you suspect your symptoms could be due to Monkeypox, wear a mask and cover your skin with clothing when seeking care.
CAN THE VIRUS SPREAD THROUGH BLOOD TRANSFUSION?
You should never give blood when feeling unwell. If you have an appointment to give blood, self-assess your health and monitor any symptoms of Monkeypox and reschedule your appointment if you don’t feel well. There have not been any reports of Monkeypox spreading through blood transfusions.