New study finds that sexual activity is a promoter of transmission of monkeypox

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  • The World Health Organization recently declared monkeypox a global emergency.
  • A recent study found that 95 percent of transmission was suspected to have occurred through sexual activity.
  • Symptoms of the disease include fever, lethargy, muscle aches and headaches.


Following the World Health Organization’s declaration of monkeypox as a global emergency, a recent study has found that 95 percent of transmission was suspected to have occurred through sexual activity.

The study, which was published by the New England Journal of Medicine, examined 528 cases of confirmed human monkeypox infection from 16 countries. Conducted by scientists at the Queen Mary University of London, it found that the current spread has disproportionately affected men who are bisexual and men who have sex with men.

“Overall, 98 percent of the persons with infection were gay or bisexual men, and 75 percent were White. The median age was 38 years. A total of 41 percent of the persons were living with HIV infection, and in the vast majority of these persons, HIV infection was well controlled; 96 percent of those with HIV infection were taking ART, and in 95 percent the HIV viral load was less than 50 copies per millilitre,” the study reads.

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“Although the current outbreak is disproportionately affecting gay or bisexual men and other men who have sex with men, monkeypox is no more a ‘gay disease’ than it is an ‘African disease’. It can affect anyone. We identified nine heterosexual men with monkeypox,” said the authors in the study.

Findings from the study further revealed that the lesions were primarily located around the genitals, the anal and oral mucosal areas, indicating a strong likelihood of sexual transmission.

“The suspected means of monkeypox virus transmission as reported by the clinician was sexual close contact in 95 percent of the persons. It was not possible to confirm sexual transmission. A sexual history was recorded in 406 of 528 persons; among these 406 persons, the median number of sex partners in the previous 3 months was 5 partners, 147 (28 percent) reported travel abroad in the month before diagnosis, and 103 (20 percent) had attended large gatherings (>30 persons), such as Pride events. Overall, 169 (32 percent) were known to have visited sex-on-site venues within the previous month, and 106 (20 percent) reported engaging in “chemsex” (i.e., sex associated with drugs such as mephedrone and crystal methamphetamine) in the same period,” the authors continue.

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However, skin lesions were not the only symptoms found in the study. Other common symptoms included fever in 62 percent of cases, lethargy in 41 percent, muscle aches in 31 percent and headaches in 27 percent.

Here’s what you need to know about monkeypox according to the National Institute for Communicable Diseases (NICD) :

Transmission - Monkeypox virus can be transmitted to a person upon contact with the virus from an animal, human or materials contaminated with the virus. Entry of the virus is through broken skin, respiratory tract or the mucous membranes (eyes, nose or mouth). In endemic countries, the monkeypox virus may be spread by handling infected bush meat, an animal bite or scratch, body fluids and contaminated objects.

Symptoms - The incubation period (time from infection to symptoms) for monkeypox is on average seven to 14 days but can range from five to 21 days. Initial symptoms include fever, headache, muscle aches, backache, chills and exhaustion. Within one to three days of the onset of disease, blister-like lesions (very much the same as chickenpox) will develop on the face, the extremities including soles of the feet and palms of the hands.

The lesions may, however, occur on other parts of the body. The number of lesions will vary and not all lesions will be at the same stage of development. The lesions progress through several stages before scabbing over and resolving. Most human cases resolve within two to three weeks of onset without side effects. The case fatality rate in more recent outbreaks have been on average one percent.

Prevention - In non-endemic countries, persons are most likely to be exposed to monkeypox through contact with an individual that is already sick with it. The spread of monkeypox can then be interrupted by contact tracing for diagnosed persons and isolating any persons that develop the disease. Residual immunity from smallpox vaccination in the population aged 40 and above may also contribute to preventing cases or lead to more mild infections. There is about 85 percent protection offered by the smallpox vaccine (which was used to eradicate the human pox virus disease known as smallpox) and monkeypox.

Risk of contracting monkeypox in South Africa - The implications for South Africa are that the risk of importation of monkeypox is a reality as lessons learnt from Covid-19 have illustrated that outbreaks in other parts of the world can fast become a global concern. The World Health Organization has not recommended any travel restrictions and are working with the affected countries to limit transmission and determine sources of exposure.

For anybody entering South Africa, any illness during travel or upon return from an endemic area should be reported to a healthcare professional, including information about all recent travel, immunisation history and contact with any known cases. Residents and travellers to endemic countries should avoid contact with sick animals that could harbour monkeypox virus such as rodents, marsupials and primates, and should refrain from eating or handling wild game. A good history is important to rule out any other differential diagnoses, including malaria.

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