New research analyzed 528 cases of monkeypox and concluded that 95% of infections occurred during sexual contact. The disease is not considered a sexually transmitted infection (STI), but is spread mainly by contacts during sex in this new outbreak, considered a public emergency of global concern by the WHO (World Health Organization).
Brazil recorded 607 cases of the disease until last Friday (22). The balance is more than double verified on the 9th, when there were 218 confirmed diagnoses across the country.
Only the state of São Paulo accumulated 590 cases until this Monday (25).
The new study was published last Thursday (21) in the New England Journal of Medicine. The 528 cases analyzed in the survey were registered in 16 countries – Brazil is not part of the sample – between April and June this year.
The research points out that 95% of infections were due to close contact that happened during sex. The conclusion, although it is not possible to fully confirm it, involves the fact that 406 of the participants had a recent history of sexual activity with an average of five sexual partners in the last three months.
The vast majority of those infected were gay or bisexual men – they represented 98% of the participants. Clarissa Damaso, who did not sign the study and is a virologist at the UFRJ (Federal University of Rio de Janeiro), says that this demographic profile was already observed in most countries with new diagnoses of the disease.
The WHO had also warned that the spread of the disease occurs mainly in men who have sex with other men. According to the organization, 90% of confirmed cases are in this population – a percentage close to that found in the new research.
One fear is that this scenario causes stigma for men who have sex with men. “Stigma and discrimination can be more dangerous than any virus,” said Tedros Adhanom, the organization’s director general.
In the newly published study, semen from 32 patients was analyzed for the presence of monkeypox DNA, the virus that causes monkeypox. Of this number, 29 recorded the presence of the pathogen.
Other research had already identified the virus in the semen of patients. However, none have identified the active virus in semen or vaginal fluid, says Damaso. It is for this reason that monkeypox is not considered an STI.
Even so, the authors of the study explain that the presence of the virus in the semen is an indication that the transmission must have occurred, mostly, through sexual contact.
The presence of lesions located in the genital, anal and oral regions is another evidence of the research that confirms the hypothesis of transmission through sexual contact. This pattern had already been recognized, says Damaso, who is also one of the researchers who make up the working group to combat monkeypox organized at UFRJ.
She states that the lesions caused by monkeypox, in its most common condition, occur mainly on the extremities: arms, legs and faces, for example. “Having genital damage is not characteristic of monkeypox, except in this current outbreak if there has been transmission through sexual contact.”
The virologist says that there are already cases of patients who do not notice other symptoms common to monkeypox, such as fever, and only present lesions in the genitalia, anus or oral region.
“This situation that varies a lot is what has been a problem in the identification on the part of those who attend”, he says.
Therefore, Damaso says that, at the present time, the appearance of lesions should already make the patient a suspect for monkeypox in order to avoid discarding cases that may be caused by the disease.
Monkeypox and STIs
Even though it is not considered an STI, increasing evidence about the transmission of monkeypox by sexual contact brings the disease closer to these infections.
One example is from the just-published study itself, in which 377 participants with monkeypox were tested for STIs and about 29% tested positive for one of these other infections.
Data like this show that it is possible to have monkeypox co-infection with other STIs. Damaso says this is important because some health professionals may consider that if the patient tests positive for some of the sexually transmitted infections, the test for monkeypox could be ruled out – something she condemns.
“You cannot rule out monkeypox if the person tests positive for secondary syphilis or gonorrhea, for example,” he concludes.
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