Monkeypox Hype being driven overwhelmingly by sex between men, major study finds
The global monkeypox outbreak is primarily being driven by sex between men, according to the first major peer-reviewed paper to analyze a large set of cases of the virus.
The outbreak, which epidemiologists believe initially began in mid-spring gatherings of gay and bisexual men in Europe, has since alarmed such experts by ballooning to nearly 16,000 cases worldwide.
Now infectious disease specialists are developing an increasingly refined understanding of the predominant conduits of monkeypox transmission, as well as the typical disease course patterns.
"These data point clearly to the fact that infections are so far almost exclusively occurring among men who have sex with men," said Jennifer Nuzzo, an epidemiologist at Brown University, of the new study, which was published Thursday in the New England Journal of Medicine. "And the clinical presentation of these infections suggest that sexual transmission, not just close physical contact, may be helping spread the virus among this population."
This large, multicountry study provides the most complete set of clinical and demographic data on monkeypox cases occurring outside endemic areas," said Nuzzo, who was not involved with the study.
No one has died of monkeypox infection outside of Africa during this outbreak. And for many people, the disease is relatively mild and resolves on its own in a few weeks without any need for medical intervention. However, the new paper reports that monkeypox can cause pain so intense that a substantial proportion of people with the virus require hospitalization for pain management.
"We have seen patients with severe rectal pain that worsens every time they go to the bathroom, genital pain every time they urinate and throat pain every time they swallow," said Dr. Jason Zucker, an infectious disease specialist at Columbia University Department of Medicine.
In the United States, confirmed cases of monkeypox have increased dramatically in recent weeks, to 2,593 as of Thursday. With fears mounting among infectious disease experts that the virus will become endemic in the U.S. and around the world, the Biden administration has been subject to intense criticism by activists and the public health community that its health agencies failed to act quickly enough to stem the outbreak.
The recent sharp rise in U.S. monkeypox diagnoses could be driven in part by increased testing, especially after the Centers for Disease Control and Prevention brought onboard five commercial testing companies during the past two weeks.
Public health experts also theorize that major LGBTQ Pride gatherings in June may have facilitated transmission of the virus. And given the infection's incubation period - the new paper puts it at seven days, with a range of three to 20 days - the nation is now possibly seeing the resulting downstream effects of sexual encounters in late June and early July.
For the new study, a consortium of scores of researchers pooled data on 528 cases of monkeypox that were diagnosed between April 27 and June 24 at 43 sites in 16 countries. These cases included 84 people (16%) in the Americas and 444 (84%) in Europe, Israel and Australia.
All the cases were among men, including one transgender man, 98% of whom identified as gay or bisexual. This stark demographic finding is in keeping with data on the outbreak from around the world, such as a recent report from the British Health Security Agency finding that of the 699 monkeypox cases for which there was available information, 97% were in gay, bisexual or other men who have sex with men. New York City, the U.S. epicenter, has seen only one woman diagnosed with the virus out of 639 cases confirmed through July 19.
Accordingly, the European Centre for Disease Prevention and Control has characterized the risk of monkeypox to the general public, in particular those not engaging in sex with multiple partners, as "very low." In a recent meeting, Dr. Agam Rao, a medical officer in the CDC's Division of High Consequence Pathogens and Pathology, used the same words to characterize the general public's risk.
In the new global study, the men had a median age of 38 and ranged between 18 and 68 years old. Three quarters are white, and 41% have HIV.