Monkey pox is not considered a traditional STD as it is mainly spread through close contact with lesions. However, global data suggests that skin-to-skin contact during sex is fueling an epidemic that has caused more than 7,000 infections in the United States and 26,000 worldwide. Cases which have been analyzed in detail show that infections are predominantly gay.
Last week, a World Health Organization leader said men who have sex with men should consider temporarily reducing the number of sexual partners or stop adding new ones to contain the outbreak, starting a debate on whether calls for sexual restraint are harmful and stigmatizing .
As monkey pox attacks gays, officials discuss warnings to limit partners
The new CDC sexual health guidelines reflect comments from WHO Director General Tedros Adhanom Ghebreyesus, though not so bluntly. It does not distinguish between men who have sex with men. CDC guidelines say that the risk of exposure can be reduced by restricting sexual partners, avoiding spaces such as sex clubs where there is anonymous sexual contact with multiple partners, and wearing clothing, including leather or latex, during sex as a skin-to-skin barrier.
The guidelines emphasize that behavioral changes may be temporary until the person is fully vaccinated with two doses of monkey pox. Although the United States is distributing hundreds of thousands of doses of vaccines in the coming weeks, it is not enough to vaccinate everyone who qualifies, and some jurisdictions only give one of the two injections to stretch limited stocks.
“These temporary changes will help slow the spread of monkey pox until there is sufficient vaccine supply,” say CDC guidelines.
Prior to the update, the CDC recommended that only people with confirmed or suspected cases of monkey pox should not be sexually active.
Public health authorities generally emphasize ways to reduce the risk of contracting disease through sex, rather than urging people to avoid sex. Some public health officials and experts say people will make their own decisions to refrain from risky sexual activity when they receive information about viruses and how they spread.
Ask the Post: What questions do you have about monkey pox?
Monkey pox is a challenge for public health officials because it can be transmitted outside of sexual activity, for example by cuddling or sharing contaminated bedding, and condoms do not provide complete protection from exposure to the rash.
Some public health experts argue that recommending a temporary reduction in sexual activity does not amount to a call for abstinence, which is widely regarded as ineffective by disease prevention specialists.
“This is not forever. That is the case for now, and as we work to scale up biomedical interventions, ”said Demetre Daskalakis, a top Biden administration official who led the response to monkey pox, who has experience in HIV prevention, said in an interview with reporters on Friday.
The CDC did not widely promote its new guidelines after they were published online on Friday. The tweet and accompanying video linking the changes made no mention of the new recommendations for reducing exposure, including limiting sexual partners. Daskalakis said officials will turn to credible organizations in the hardest hit communities to help promote preventive messages.
While the CDC guidelines do 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 cases of men with detailed information, 94 percent reported having intimate or sexual contact with another man in the three weeks prior to the onset of symptoms.
Nearly 300 men gave additional details about their sexual activity during this 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 partners.
Monkey pox causes flu-like symptoms, including fever, swollen lymph nodes, and a rash that can spread throughout the body. Doctors are seeing more lesions around the genitals, mouth, and anus of patients in the recent outbreak suspected of being related to sexual transmission.
In 291 cases with detailed symptom data, 42 percent of patients did not report flu-like symptoms before the onset of the rash, which is usually seen in patients with monkey pox. In the sample containing detailed information on the location of the rash, nearly half reported it around the genitals.
Monkey pox exposes inequalities in the gay community when people struggle to access care
The CDC data also showed that people of color had an incidence of monkey pox disproportionate to their presence in the overall population.
In more than 1,000 cases where race and ethnicity were reported, 41 percent were White, 28 percent were Hispanic, and 26 percent were Black.
Blacks are disproportionately affected by cases as the epidemic grows, ranging from 12% of cases between May 17 and July 2, to nearly a third between July 3 and 22.