Monkey pox: why are gay and bisexual men affected more?

Monkey pox: why are gay and bisexual men affected more?

On the left, cells are observed

monkeypox (monkeypox in English) has caused no deaths in Europe, but the disease is spreading. With nearly 17,000 cases worldwide, WHO Director-General Tedros Adhanom Ghebreyesus raised the highest alert level for monkeypox on July 23. France’s public health authority (SPF) has identified 1,567 patients in the country since May; 3% of them were hospitalized. This epidemic differs from the waves observed so far in dozens of African countriesAnd the In particular through a profile of patients: the cases are almost exclusively of men and most of them have had sexual relations with other men – people called “MSM”.

Read also: Monkey pox: how is it transmitted and what are its symptoms?
Pictures showing examples of monkeypox rashes were collected from the Centers for Disease Control and Prevention in the United Kingdom.

Why is MSM overrepresented among patients? First, keep in mind that SPF numbers are not necessarily incomplete. The examination is in its initial stages and is complicated by the fact that the symptoms are nonspecific. “This virus behaves like a great imitation of herpes or syphilis. So the diagnosis is easy to miss., confirms Benjamin Davido, an infectious disease specialist at Raymond Poincaré Hospital, in Garches (Hauts-de-Seine). In addition to symptoms usually reported in endemic areas, some patients develop new conditions such as angina or proctitis (inflammation of the rectal mucosa).

“Anyone in close physical contact with another person who has had monkeypox is at risk, regardless of their sexual orientation,” says Yannick Simonin.

Monkeypox is transmitted by direct contact, including through mucous membranes and skin lesions or by contact with contaminated surfaces or objects. It can also be transmitted by respiratory droplets, over a short distance and during prolonged face-to-face exposure. “Anyone who has close physical contact with another person who has had monkeypox is at risk, regardless of sexual orientation,” Yannick Simonin, a lecturer at the University of Montpellier and a specialist in emerging viruses, confirms, who calls for “Be careful not to stigmatize the LGBT community” : “Monkey pox is not unique to this community, although cases are currently overrepresented there.”

Regardless of sexual orientation, the main factor of prevalence remains multiple sexual partners: 74% of reported cases report having more than two sexual partners in the three weeks prior to the onset of symptoms. Of the cases investigated, 26% are HIV-positive.

Read the interview: This article is reserved for our subscribers Monkeypox: ‘If we let messages stigmatizing homosexuals spread, it will have public health consequences’

“We lack complete information, but data instead confirm a single pre-spreader event and then spread, particularly in the MSM community, after superspreader events.”, says Mr. Simonin. Thus the outbreaks in Spain and Belgium could be the reason for the very rapid spread of the virus within the LGBT community. One hundred positive cases were detected after Gay Pride in Yumbo in Maspalomas, Canary Islands, while another outbreak appeared at the same time at the Darklands Festival in Belgium in early May. However, monkeypox was already spreading before these festive events. While patient zero is unknown, Spanish health authorities identified asymptomatic cases of the disease in Madrid as early as April, according to reports. El País.

Is monkeypox a sexually transmitted disease?

Besides the high risk of contamination attributed to close contacts, the scientific community is closely watching the virus’ development into a sexually transmitted infection (STI). Studies conducted in Italy and Germany have shown the presence of the virus in the semen of some patients, although scientists have not established its contagious nature. SPF data provided further evidence: 78% of patients had anal rash. Remember that virologist Yannick SimoninA sexually transmitted infection is a disease that is transmitted during sexual contact and does not necessarily mean the presence of a virus in sexual secretions.. As he explains, “The current hypothesis is that transmission of this virus during sexual intercourse largely occurs at the level of lesions of the mucous membranes, in particular at the level of the anogenital region.”

A vaccine that is 85% effective is the only way to prevent monkeypox at present. It is not enough to wear a condom alone, which distinguishes among other things monkeypox from sexually transmitted diseases

Benjamin Davido adds: “These lesions are contagious and contagious. There may have been mutations in the virus that changed the chains of transmission. So it is not excluded that this virus could become an STD.” Statements tinged with uncertainty at the moment. The sequence of the virus’s genome, six times longer than that of SARS-CoV-2, should make it possible to confirm the evolution of transmission routes, as described in this journal article. temper nature. Yet Yannick Simonin weighs in: It is also possible that this mode of transmission has been greatly underestimated in regions where this virus is endemic, and has not been relatively studied. » Vaccination is the key to stopping the epidemic. According to Benjamin Davido, “The protocol to isolate the tracer – the test – is not appropriate for this pandemic. We are in a fateful period. I am calling for the vaccination of people at risk to be completed by the start of the school year. A vaccine that is 85% effective is the only way to prevent monkeypox at present. It is not enough to wear a condom alone, which distinguishes, among other things, monkeypox from an STD.

In addition to the identified contact cases, the Supreme Health Authority extended preventive vaccination, on July 11, to men who have sex with men, transgender multiple-partners, sex workers and professionals working in places of sexual consumption. With smallpox vaccination on hold since 1984 after the disease was eradicated, the country has kept doses to protect against a bioterrorist attack. Although their number is classified for secret defense, the general trend of health released 7,500 potions and then 5,000 potions in mid-July. In response to a question from Franceinfo, the DGS announced that 30,000 doses have already been withdrawn from strategic stocks, of which 20,000 are already in the field.

“Scaling up vaccination at the moment does not seem necessary to me, especially since we don’t know how many doses are available, so the priority is really to vaccinate those at risk”, says virologist Yannick Simonin. On social networks, testimonies multiply and associations for the fight against AIDS multiply, Aides et behavior In particular, advocate for an acceleration of the vaccination campaign.

Eventually, the virus can pass from humans to animals and develop into a zoonotic disease. “We can create a kind of reservoir for this virus in Europe that will preserve it for much longer periods and make Europe an endemic area.”Simonen, who recommends that people with the disease avoid contact with pets, confirms.

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