Let’s all take a moment to admit that the last few years haven’t been some of our best. We’ve had a global pandemic that’s killed millions of people, political unrest, record inflation, natural disasters, gun violence, racism, etc., etc., etc. So, it should come as no shock to us that we’re now faced with a new scourge on the block – monkeypox. Even more distressing to my LGBTQ+ community members is the fact that men who have sex with men are at ground zero for this new outbreak.
You may find yourself wanting to assume the fetal position in an unmarked underground bunker at the mere mention of monkeypox, and who could blame you? However, monkeypox has been around for a long time. It is a known quantity. So, before you start your solitary, subterranean existence, read through our monkeypox Q & A to find out more about this disease. As they say, knowledge is power, so it might make you feel a little less powerless to understand exactly what we’re dealing with here.
What is monkeypox?
Monkeypox is a disease that’s caused by a virus of the Orthopoxvirus genus in the family Poxviridae. It was discovered in 1958 when there was an outbreak among monkeys who were being kept for research purposes – hence the name. Monkeypox is related to the smallpox virus, which was eradicated globally by 1980. It is not related to the chickenpox virus.
The first human case of the disease was recorded in 1970. Monkeypox is regularly found in places like Cameroon, Nigeria and the Democratic Republic of Congo where it is endemic. Animals like rodents and monkeys in parts of western and central Africa serve as vectors for the zoonotic disease and are responsible for the cross-species jump to humans.
What are the symptoms of monkeypox?
Monkeypox symptoms include a rash that can look like pimples or blisters. This rash may occur externally on the hands, feet, chest, face and genitals, or it may occur internally in the mouth, anus or vagina. The rash can be itchy or painful and will usually go through different stages before scabbing over and healing.
The telltale rash may be accompanied by flu-like symptoms such as fever, headache, muscle aches, chills, swollen lymph nodes, fatigue, back pain, sore throat and cough. A person with monkeypox may only experience a few of these symptoms during their infection and cases can range from mild to severe. Most cases resolve within two to four weeks.
Is monkeypox fatal?
Not usually. According to the World Health Organization (WHO), the historic case fatality ratio of monkeypox has ranged from zero to 11 percent with more recent estimates falling in the range of three to six percent. As of July 14, 2022, there have been 1,053 confirmed monkeypox cases in the U.S. and over 11,000 cases worldwide. Out of all of these cases, the WHO has only documented three deaths, all of which have occurred in Africa.
It’s important to note that while monkeypox doesn’t carry a huge risk of death, it’s not a disease that you want to get. The lesions can be extremely painful, and they can occur on very sensitive parts of the body. Monkeypox may be a funny name, but to those who suffer through an infection, it is no laughing matter. I can assure you of that.
Why gay men?
First off, let’s emphasize the fact that monkeypox is not a “gay” disease. Viruses pay zero attention to your sexual orientation or gender identity. That being said, so far, the cases have been primarily reported in men who have sex with men. While the queer community seems to be at the greatest risk from monkeypox at the moment, it’s incredibly important that we work hard to fight any potential stigma associated with the disease.
As the New York Times explained in a recent article, “It’s an epidemiological accident of history,” that the monkeypox outbreak is affecting the gay community. The most likely explanation is that someone who was infected with the monkeypox virus attended a gay rave in Europe. Those people who were in attendance then traveled back to wherever they were from, carrying the disease with them. Monkeypox then began to spread within those same social and sexual networks in countries across the globe.
However, just because the current monkeypox outbreak began in a certain population, it doesn’t mean it will stay there. Eventually this outbreak will infect members of other populations unless it is contained. There is no immunity to monkeypox in the U.S. so there is the potential for this outbreak to continue to spread.
Is monkeypox sexually transmitted?
As far as we know, the answer is no. Monkeypox spreads through close contact with skin lesions or respiratory secretions from an infected person, usually through prolonged skin-to-skin or face-to-face contact. The disease can also spread if someone comes into contact with items that have been contaminated with fluid from monkeypox lesions including surfaces, bedding and clothing. Monkeypox may also occur between a pregnant parent and fetus before and after birth.
Researchers are actively studying the current outbreak to investigate whether monkeypox is being transmitted sexually, which would mean it’s being transmitted through semen, vaginal secretions or feces. However, since sexual activity involves the kind of intimate skin-to-skin contact that is usually responsible for the spread of the virus, it might be difficult to parse the difference in transmission.
Is there a cure?
There is no cure for monkeypox, but there are treatment options. If you suspect you have monkeypox, the first step is to get tested. If you find out that you are positive, you will need to isolate yourself from others until your skin lesions heal completely, meaning that there is no scab and a new layer of skin has formed. Until then, you should rest and drink plenty of fluids. You should also contact anyone that you’ve had close skin-to-skin contact with in the previous 14 days.
Medications may be prescribed to help with pain, itching or sleep. One patient reported that Vaseline was a lifesaver because it protected his lesions from being irritated by air. There is also an antiviral medication called tecovirimat that is used to treat monkeypox, but as of right now, it’s not widely available. There is a danger of secondary bacterial infection of the lesions, so you should be on the lookout for signs of infection and seek medical attention promptly if you suspect one or more of your lesions has become infected.
Should I get vaccinated?
To date, there have been more than 132,000 doses of the monkeypox vaccine, Jynneos, distributed in the U.S. An additional 2.5 million doses of Jynneos were ordered by the U.S. on July 1, which will bring the national stockpile to more than 4 million doses. However, many people seeking vaccination have found that the doses are in short supply and that it’s difficult to make an appointment to get one.
Despite the long lines and multiple tries it may take to get a vaccine, it’s still worth it to try to get one if you have been recently exposed or if you have or intend to have multiple sexual partners in an area where monkeypox is spreading. There is some data that show that a vaccine given promptly after exposure can mitigate symptoms. An exposure would qualify as any close contact or sexual activity with an infected person within the past 14 days.
The Jynneos vaccine is taken as two doses given four weeks apart. However, some say that delaying the second dose may supply the same protection while helping to ease supply shortages. Paul Chaplin, CEO of Bavarian Nordic, the company that manufactures Jynneos, said that a second dose could be delayed up to two years after the first dose and still provide the same immunity. However, health experts are currently not recommending anyone forgo that second dose just yet.
Where is monkeypox spreading in the U.S.?
So far, there have been only 9 states that have not reported a single monkeypox case. Those states are Alaska, Alabama, Maine, Mississippi, Montana, North Dakota, Vermont and Wyoming.
How do I get tested?
This is a tricky one. You would have thought that we would have learned a lesson or two with the COVID-19 pandemic. However, when it comes to testing, it looks like we didn’t learn as much as we should have. Anecdotally, it seems that people who are looking for tests are getting the runaround. Some are being told to go to a primary care doctor or the emergency room or their local health department. As with vaccination, many are facing long lines and long wait times for tests.
However, if you suspect that you have monkeypox, it is important that you get tested to receive a definitive diagnosis. Knowing how and where monkeypox is spreading can help to allocate resources and facilitate contact tracing. Start with your primary care doctor and go from there.
How do I stay safe?
The CDC just released guidelines for navigating social and sexual settings during the monkeypox outbreak. In it, they suggest that you choose activities and gatherings where people are fully clothed without prolonged skin-to-skin contact. They also caution that going to places like sex clubs, sex parties and other locales where anonymous sex with multiple partners occurs may put you at a higher risk of contracting the disease.
It’s all a giant buzzkill, I know. Here’s the thing though. We want to protect members of our community without assigning any shame or blame for your sex game. If you’re a consenting adult and your entire social life centers around prolonged skin-to-skin contact with as many people as possible, more power to you. However, if you are not in a monogamous relationship, you probably want to go out and get yourself vaccinated ASAP. And if you have any symptoms of monkeypox, do us all a solid and stay home until you’re totally well.
One big, beautiful silver lining is that the LGBTQ+ community knows how to come together to fight infectious disease. We understand the importance of reporting cases and the need for contact tracing. We’ve had 40 years of practice dealing with outbreaks, and we know how to protect each other and care for one another. No matter what challenges this year or future years may bring, we can rest easy knowing that we have the power to get through it together.