Monkeypox is not considered a traditional sexually transmitted disease because it is spread primarily through close contact with lesions. But global data suggests that skin-to-skin contact during sex is fueling the outbreak, which has led to more than 7,000 infections in the United States and 26,000 worldwide. Cases that have been reviewed in detail show that infections are overwhelmingly among gay men.
Last week, the head of the World Health Organization said that men who have sex with men should consider temporarily reducing their number of sexual partners or stopping adding new ones to help stop the outbreak, sparking debate over whether calls for sexual restraint are counterproductive and stigmatizing
As monkeypox strikes gay men, officials debate warnings to limit partnerships
The CDC’s new sexual health guidance echoes comments from WHO Director-General Tedros Adhanom Ghebreyesus, though not as directly. It does not highlight men who have sex with men. CDC guidance says the risk of exposure can be reduced by limiting sexual partners, avoiding spaces like sex clubs where anonymous sexual contact with multiple partners occurs, and wearing clothing, including leather or latex, during sex as a skin-to-skin barrier.
The guidance emphasizes that behavioral changes may be temporary until a person is fully vaccinated with two doses of monkeypox. Although the United States is distributing hundreds of thousands of vaccine doses in the coming weeks, there are not enough to vaccinate everyone who is eligible, and some jurisdictions are giving only one of two shots to stretch limited supplies.
“These temporary changes will help slow the spread of monkeypox until the vaccine supply is adequate,” the CDC guidance says.
Before the update, the CDC had only advised people with confirmed or suspected cases of monkeypox to refrain from sexual activity.
Public health authorities generally emphasize ways to reduce the risk of contracting disease during sex rather than urging people to avoid sex. Some officials and public health experts say people will make their own decisions about abstaining from high-risk sexual activity when presented with information about viruses and how they spread.
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Monkeypox has presented messaging challenges for public health officials because it can be transmitted outside of sexual activity, such as cuddling or sharing contaminated bedding, and because condoms don’t offer full protection against exposure to rashes.
Some public health experts say that recommending a temporary reduction in sexual activity does not amount to a call for abstinence, which is considered ineffective by disease prevention specialists.
“This is not something forever. It’s something for now and as we work to scale up biomedical interventions,” Demetre Daskalakis, a senior Biden administration official who leads the monkeypox response and has experience in HIV prevention, said on a call with reporters. on Friday.
The CDC did not widely promote its new guidance after posting it online Friday. An accompanying tweet and video with a link to the changes made no mention of the new recommendations to reduce exposure, including limiting sexual partners. Daskalakis said officials will turn to credible organizations in the hardest-hit communities to help promote prevention messages.
Although the CDC’s guidance does not mention sexual orientation or gender identity, data released by the agency on Friday shows that infections remain overwhelmingly among men who have sex with men.
In 358 male cases with detailed information, 94 percent report intimate or sexual contact with another man during the three weeks before developing symptoms.
Nearly 300 men provided additional details about their sexual activity in that three-week period: 40 percent reported two to four partners, 27 percent reported one partner, 19 percent reported 10 or more partners, and 14 percent reported five to nine pairs.
Monkeypox causes flu-like symptoms, including fever, swollen lymph nodes, and a rash that can spread over the entire body. Doctors are seeing more lesions around the genitalia, mouth and anus of patients from the latest outbreak, which are suspected to be related to sexual transmission.
In 291 cases with detailed symptom data, 42 percent of patients reported no flu-like symptoms before developing rashes, as is typically seen in monkeypox patients. In a sample with detailed information on the location of rashes, just under half reported rashes around the genitals.
Monkeypox exposes inequalities in the gay community as people struggle to access care
CDC data also showed that people of color are bearing the burden of monkeypox cases at levels disproportionate to their presence in the general population.
In more than 1,000 cases with reported race and ethnicity, 41 percent were white, 28 percent were Hispanic, and 26 percent were black.
Cases are disproportionately affecting Black people as the outbreak grows, from 12 percent of cases between May 17 and July 2 to nearly a third of cases between July 3 and July 22. of July.