How Worried Should Men Be About Monkeypox? We Asked an Epidemiologist and Queer Health Specialist

Monkeypox, what is monkeypox
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Monkeypox is the latest viral disease making headlines after the W.H.O declared it a global health emergency on July 23, 2022, after nearly 17,000 cases were detected in 68 countries that don’t usually see the disease. This declaration has prompted an international response, and this includes the United States., where 4,639 cases have been detected to date.

After two plus years of the COVID-19 pandemic, the world is a little on edge regarding viral disease outbreaks, and so far, health experts have agreed it’s unlikely monkeypox will create a situation similar to COVID. There are key differences between Monkeypox and the coronavirus. Mainly, we already have effective vaccines and treatments. However, it’s still worth learning how you can best protect yourself from infection.

As Monkeypox spreads more widely, we’ve seen a lot of information and misinformation spreading online. We’ve also seen questionable advice, such as to avoid trying on clothing at stores. So can you catch Monkeypox by trying on clothes at a store? What about sharing a subway or bus with an infected individual?

To separate fact from fiction, we spoke with a professor of epidemiology and Dean of the School of Public Health at the University of Nebraska Medical Center, Dr. Ali S. Khan, about this latest outbreak, where it came from and how individuals can best protect themselves. We also spoke with Dr. Carlton Thomas, a Mayo Clinic-trained, board-certified gastroenterologist at Digestive Disease Associates in San Diego, California. He’s also known as @DoctorCarlton on Instagram and TikTok and specializes in creating health and wellness content for the LGBTQ+ community.

At present, Monkeypox is primarily spreading among gay men in the United States, and Dr. Carlton told us that will inevitably shape how the public, the media, and the government respond to the outbreak.

“The media and the world is homophobic. A lot of us feel like if pretty, young straight people were affected by this, then the government would have acted sooner,” Dr. Carlton said.

  

What Is Monkeypox? How Does It Spread?

“MonkeyPox is a zoonotic virus of the Orthopoxvirus genus. It typically was found in Africa and spread by animal-to-human contact,” Dr. Carlton said in an interview with SPY.

It’s a virus similar to smallpox that was first detected in monkeys in captivity in 1958. That’s how the virus got its name, but the leading carriers are thought to be rodents. It’s most common in Central and West Africa, spreading through close contact with animals. The first human case occurred in 1970, and since then, it’s occasionally caused small outbreaks, mostly limited to 11 countries in Africa, including the Democratic Republic of Congo.

Monkeypox spreads via skin-to-skin contact with infection lesions and by touching infected or shared items with an infected person. It can also be spread from mother to child via placenta and close contact before and after birth. It can spread easily between sexual partners but is not thought to spread through semen or bodily fluids, and therefore it’s not a sexually transmitted infection (STI) in the traditional sense. We’ll dive deeper into this distinction later on.

Both doctors we spoke to clarified that monkeypox spreading via casual contact, like a subway ride with an infected person or trying on clothes someone else has worn in a changing room, is rare.

“It’s possible to spread this way theoretically but less likely than close contact,” said Dr. Carlton.

  

What Are the Symptoms of Monkeypox?

According to the CDC, monkeypox is typically a mild illness, and while it’s related to smallpox and shares similar symptoms, the symptoms are far milder and rarely fatal. Monkeypox is also not related to the chickenpox virus.

Symptoms of monkeypox can include:

  • Fever
  • Headache
  • General exhaustion
  • Chills
  • Swollen lymph nodes
  • A rash with pimples and blisters that can appear anywhere on the body — including the face, inside the mouth, on the hands, feet, chest and even genitals

Beginning to end, the illness generally lasts 2-4 weeks and resolves on its own.

While there are no treatments specifically for monkeypox, antiviral medications and vaccines designed for smallpox can help prevent monkeypox infection. If you think you have symptoms of monkeypox, you should reach out to your healthcare provider immediately.

  

The Current Monkeypox Outbreak in the United States

Here in the United States, Monkeypox is spreading almost exclusively among gay and bisexual men, and experts have specifically cited sex parties, fetish events and gay raves as early superspreader events. This presents a challenge for public health officials, who want to issue clear guidance without stigmatizing marginalized communities.

“What’s different about the current outbreak is it’s happening mostly in men who have sex with men at the moment, so these lesions are now also being seen in the anorectum, penis and mouth/throat, as it is being spread through close contact during sex,” said Dr. Carlton.

“The secretions from these lesions are highly infectious. So the current main mode of transmission is close, prolonged contact as in sex, dancing shirtless in crowded spaces. Prolonged respiratory droplet exposure, as in deep kissing, is also a risk. The secretions can typically be left on clothes and linen, but the transmission seems low this way as of now.”

Monkeypox outbreak The current global monkeypox outbreak includes nearly 17,000 cases as of July 2022. Courtesy of the Center for Disease Control (CDC)

Dr. Khan explained that “the new variant of monkeypox — exclusively transmitted from close skin to skin contact of infected persons; especially sex — has likely been causing disease for 4-5 years and silently spreading in communities.

“More recently, it spread worldwide with 16,000 cases in 75 countries following large sex raves, festivals and attendance at bathhouses. The large number reflects better recognition and testing following the initial recognition of this outbreak in the spring and is still likely an underestimate of the real number of cases worldwide.”

  

How Serious Is the Current Outbreak?

Dr. Carlton shared that while the disease itself is unlikely to result in death, the emotional, physical and financial costs of contracting the virus are still very high. The skin lesions and fever can also be extremely painful.

“The older version of this virus had a 1-10% death rate, but there have been only a few deaths in this outbreak so far,” said Dr. Carlton.

“It can cause severe pain, especially in rectal, urethral, and throat infections. Isolation is often required for up to a month until all lesions crust up and fall off. The financial and psychological burden of this is high!”

Dr. Khan said, “95% of cases are due to sexual transmission, almost all among gay and bisexual men. No deaths have been reported in the United States. Approximately 10-15% of patients are hospitalized.” He also clarified that the disease is “not spread by casual contact.”

  

Crowd raising and holding rainbow gay flags during a Gay Pride. Trans flags can be seen as well in the background. The rainbow flag is one of the symbols of the LGBTQ community Picture of a crowd of people holding and raising rainbow flags, symbol of the homosexual struggle, during a gay demonstration. The rainbow flag, commonly known as the gay pride flag or LGBT pride flag, is a symbol of lesbian, gay, bisexual and transgender (LGBT) pride and LGBT social movements. Other older uses of rainbow flags include a symbol of peace. Licensed from Adobe

The Current Monkeypox Outbreak and the LGBTQ+ Community

We also asked Dr. Carlton, an LGBTQ+ health specialist and an impactful resource in the community, if this disease was, in fact, predominantly affecting the LGBTQ+ community or if this was a homophobic generalization being made by the news media to quell panic about another pandemic.

He explained that, yes, this disease is spreading amongst men who have sex with other men.

“This outbreak reportedly started at a gay pride event in Gran Canaria, and due to the nature of travel during the late spring and summer with Pride events all over the world, there was a huge cross-pollination of cities due to the nature of international travel and the fact that gays travel a lot to events,” said Dr. Carlton.

“It’s not a gay disease or an STI by definition, but this is the way it seems to be spreading right now. Over 95% of cases are in gay men,” he said. “We were left behind and trashed in the AIDS epidemic. This is eerily similar except that now you generally don’t die from this infection.”

SPY asked Dr. Carlton and Dr. Khan about a recent story published in Bari Weiss’s newsletter by Donald G McNeil Jr., a former science reporter for The New York Times who cited sex parties as a major locus of spread and recommended postponing events like that until the outbreak is under control. Specifically, we wanted to know how public health officials and journalists can provide needed public health guidance without stigmatizing and marginalizing certain groups. While the assessment that Monkeypox is spreading through sex parties might make some people uncomfortable, it’s the reality of the situation.

“I agree with them right now. Although we need the government to step up with vaccines and treatment access with TPOXX (the only known treatment now that is nearly impossible to get because it is part of the national smallpox stockpile), we also need to be personally responsible in our sexual practices now. Our community party organizers need to take a pause on these big events like Market Days in Chicago,” said Dr. Carlton.

Dr. Khan also emphasized the need for personal responsibility and commended gay and bisexual men for sharing their stories and warning the rest of the world about the spread.

“Monkeypox is currently predominantly spread by sex. That is not stigmatizing. The virus does not care about your identity or sexual orientation. As opposed to stigmatizing gay and bisexual men, they should be commended for rapidly sharing information, including their own experiences and lining up for hours to be vaccinated,” said Dr. Khan.

“And yes, it is responsible to avoid sex with persons who may be infected (and if you may be infected) in high-risk situations till individuals are fully protected by vaccination. This is analogous to shutting down a facility responsible for a deadly food-borne infection. You avoid until appropriate prevention steps are put in place.”

  

Remember: Anyone Can Get Monkeypox

While this disease is mostly spreading within a particular community, that doesn’t mean those are the only people getting it. As we detect and diagnose more cases, including those in children, we’re learning that anyone who comes into close contact with an infected person is at risk of contracting it. The inclination to label this a “gay” disease is stigmatizing and harmful to those in the community and out, as anyone, regardless of sexual orientation, can contract monkeypox.

The W.H.O clarified on Monday, July 25, that there’s little evidence to suggest this outbreak will continue to be confined to those communities and that we should all avoid complacency. In reality, their early detection of the disease is most likely a warning sign of a larger outbreak, and we should all be vigilant and follow guidance on protecting ourselves.

  

How To Protect Yourself From Monkeypox

Dr. Khan’s advice for protecting yourself against this current outbreak was pretty straightforward. “People can protect themselves from not having sex with potentially infected persons, getting vaccinated and immediately getting tested if they suspect they have monkeypox.”

Dr. Carlton also shared simple, straightforward advice for avoiding monkeypox infection: “Avoid prolonged close intimate contact with random people, be aware of the symptoms, and, if you are at high risk, get vaccinated.”

For more information on monkeypox, the signs and symptoms and how to get vaccinated, you can visit the CDC’s website and resource page on the outbreak. Unfortunately, vaccine appointments are extremely difficult to book at present, which is why accurate information is so important.

You can follow @DoctorCarlton on Instagram and Tik Tok, where you’ll find local resources state by state for acquiring a vaccine, getting tested and other key information.

Editor’s note: quotes have been lightly edited for grammar and clarity.