Labelling monkeypox sexually transmitted diseases / infection will lead to stigmatisation of particular community, feel experts
The monkeypox virus may be spreading through sexual contact as indicated by the initial presentation of genital or peri-anal rashes in many cases, said the World Health Organization (WHO). And now, a new study has found the presence of the virus in seminal fluid.
Reports also showed that the outbreak in several non-endemic countries was predominant in a particular social network — men who have sex with men (MSM) — a fillip to the sexual transmission theory.
This route of spread is uncharacteristic for the pathogen, just like the geographical vastness of the current outbreak, with most cases having no travel history to endemic countries. Typically, the virus spreads through close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding, the United Nations health agency noted.
A report published on June 2, 2022 in Eurosurveillance — Europe's journal on infectious disease surveillance, epidemiology, prevention and control — studies the epidemiological, clinical and virological characteristics of four cases of monkeypox in Italy.
Four men in their 30s, who belong to the MSM community, tested positive for the monkeypox virus following travel in the first two weeks of May. Three went for a mass gathering event in Gran Canary island, while one travelled for sex work. All four have a history of STIs and two are HIV positive.
As is being observed across the world, their lesions emerged in the anal and genital area. Among the key findings of this study was the presence of the monkeypox virus in the seminal fluid.
“Although these findings cannot be considered definitive evidence of infectivity, they demonstrate viral shedding whose efficiency in terms of transmission cannot be ruled out,” the authors noted.
While these findings are important, it’s not enough evidence to suggest sexual transmission of monkeypox, said David Heymann, former head of WHO’s emergencies department, stressing that it’s not a sexually transmitted disease. “We need to understand all different means of transmission. What we are certain about is that the virus transmits through physical contact.”
An infection is called an STI when it’s transmitted almost exclusively by sexual intercourse. “Based on our current understanding, monkeypox is not an STI. It transmits during sexual relations if there are lesions in the genital area,” he explained.
Monkeypox is behaving quite differently from how it has been understood to spread in African countries where it is endemic, said James O Lloyd-Smith, professor of ecology and evolutionary biology at the University of California, Los Angeles.
He told Down To Earth:
The virus appears to have gotten into some particular social networks, and had success spreading via close contact at parties and apparently through sexual contacts. From what is known so far, this seems to be a major driver of the spread of this outbreak outside Africa. These types of contact have never been identified as a major route of transmission in endemic countries.
Several experts fear that labelling monkeypox sexually transmitted will lead to stigmatisation of a particular community. Appropriate messaging is key, particularly in the backdrop of pride month being underway, according to them.
Boghuma Kabisen Titanji, a virologist from Emory University, argued otherwise. She explained on the microblogging platform Twitter:
Calling an infection a sexually transmitted infection (STI) is not intended to be stigmatising. It allows for people to understand how they could be exposed and potentially infected. It also helps with tracing partners, notifying them so they are aware of their exposures to seek treatment.
The disease spreading through semen, vaginal secretions or skin-to-skin contact is semantics, she added.
Monkeypox is not only infecting a particular population, but its symptoms are also not what has been typically recorded in African nations. The general progression of monkeypox symptoms begin with fever, chills and swollen lymph nodes one-two weeks after exposure, followed by a rash a few days later which develops into blister-like lesions and turns into scabs, both of which last around a day each.
Healthy tissue typically emerges two-four weeks after the onset of symptoms.
What we are witnessing now is a more milder presentation of the symptoms leading up to the rash and are therefore often missed, according to a report in JAMA Network.
Another difference is the placement of these lesions — typically beginning from the head and spreading to the arms and legs. But now, lesions are first appearing in the genital or perianal region.
However, a lot still remains unclear. “Is it the actual close, skin-to-skin contact, respiratory secretions that are spreading during sexual encounters? Or is it actually a sexually transmitted infection transmitting through body fluids that are exchanged during sex?” Amesh Adalja, a senior scholar at the Johns Hopkins Centre for Health Security in Baltimore, was quoted as saying in Bloomberg.
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