In its latest paper, New England Journal of Medicine reports that before April 2022, 98 percent of the people with the infection were gay or bisexual men

Around 98 percent of the men who contracted monkeypox earlier were gay or bisexual, but the illness is no longer exclusively a gay disease, reveals the latest study published by the New England Journal of Medicine (NEJM).

“We reported 528 infections diagnosed between April 27 and June 24, 2022, at 43 sites in 16 countries. Overall, 98% of the persons with infection were gay or bisexual men, 75% were white, and 41% had human immunodeficiency virus infection; the median age was 38 years,” says the study.

“Transmission was suspected to have occurred through sexual activity in 95% of the persons with infection.”

The current global outbreak of monkeypox virus infection in humans suggests changes in biologic aspects of the virus, changes in human behavior, or both, the study points out.

“Such changes might be driven by waning smallpox immunity, relaxation of coronavirus disease 2019 (Covid-19) prevention measures, resumption of international travel, and sexual interactions associated with large gatherings,” says the research, which covers the spread of infection across 16 countries from April–June 2022. “To date, the current spread has disproportionately affected men who are gay or bisexual and other men who have sex with men, which suggests amplification of transmission through sexual networks.”

No longer. Monkeypox, the study underlines, is no more a “gay disease” than it is an African disease.

“It can affect anyone. We identified nine heterosexual men with monkeypox,” the study says. “We urge vigilance when examining unusual acute rashes in any person, especially when rashes are combined with systemic symptoms, to avoid missing diagnoses in heterosexual persons.”

Following a worldwide upsurge in cases, WHO has issued the highest alert. More than 31,000 cases of monkeypox have been reported globally since January 1, over 10,000 of them in the United States.

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What is Monkeypox?

It is a viral zoonotic infection, meaning that it can spread from animals to humans. It can also spread from person to person.

Monkeypox can cause a range of signs and symptoms. While some people have mild symptoms, others may develop more serious symptoms and need care in a health facility. Those at higher risk for severe disease or complications include people who are pregnant, children and persons that are immuno-compromised.

The most common symptoms of monkeypox include fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes. This is followed or accompanied by the development of a rash, which can last for two to three weeks. The rash can be found on the face, palms of the hands, soles of the feet, eyes, mouth, throat, groin, and genital or anal regions of the body. The number of lesions can range from one to several thousand. Lesions begin flat, then fill with liquid before they crust over, dry up and fall off, with a fresh layer of skin forming underneath.

Symptoms typically last two to three weeks and usually go away on their own or with supportive care, such as medication for pain or fever. People remain infectious until all of the lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath.

In most cases, the symptoms of monkeypox go away on their own within a few weeks. However, in some people, an infection can lead to medical complications and even death. Newborn babies, children, and people with underlying immune deficiencies may be at risk of more serious symptoms and death from monkeypox.

Complications from monkeypox include secondary skin infections, pneumonia, confusion, and eye problems.

According to the WHO, in the past, between 1 percent to 10 percent of people with monkeypox have died. “It is important to note that death rates in different settings may differ due to a number of factors, such as access to health care. These figures may be an overestimate because surveillance for monkeypox has generally been limited in the past. In the newly affected countries where the current outbreak is taking place, there have been no deaths to date,” WHO says.

Monkeypox spreads from person to person through close contact with someone who has a monkeypox rash, including through face-to-face, skin-to-skin, mouth-to-mouth or mouth-to-skin contact, including sexual contact.

“We are still learning about how long people with monkeypox are infectious for, but generally they are considered infectious until all of their lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath,” WHO says.

Environments can become contaminated with the monkeypox virus: For example when an infectious person touches clothing, bedding, towels, objects, electronics and surfaces. Someone else who touches these items can then become infected. It is also possible to become infected from breathing in skin flakes or virus from clothing, bedding or towels. This is known as fomite transmission.

Global contagion

According to the New England Journal of Medicine (NEJM) before April 2022, monkeypox virus infection in humans was seldom reported outside African regions where it is endemic. However, currently, cases are occurring worldwide.

In the NEJM study, 95 percent of the people presented with a rash, 73 percent had anogenital lesions, and 41 percent had mucosal lesions. “Common systemic features preceding the rash included fever (62 percent), lethargy (41 percent), myalgia (31 percent), and headache (27 percent); lymphadenopathy was also common (reported in 56 percent). Concomitant sexually transmitted infections were reported in 109 of 377 persons (29 percent) who were tested,” the study revealed.

Most cases, the NEJM study found, were mild and self-limited, and there were no deaths. Although 13 percent of the patients were admitted to a hospital, no serious complications were reported in the majority of those admitted. Common reasons for admission were pain and bacterial superinfection.

“Rare serious complications (myocarditis and epiglottitis) were observed, and therefore the full spectrum of the disease and complications needs further study, particularly over the long term, given the short duration of our follow-up,” the study says