From the Guidelines
Monkeypox (mpox) is not inherently associated with the men who have sex with men (MSM) community, but rather the virus has spread within this social network due to close physical contact and epidemiological patterns of transmission. The virus can be contracted by anyone, regardless of sexual orientation or gender identity, if exposed to the virus through close physical contact, contaminated materials, or respiratory droplets during prolonged face-to-face contact 1.
Key Points
- Mpox is a viral disease that has historically been endemic in parts of Central and West Africa, with the virus naturally circulating in certain animal populations, particularly rodents and non-human primates.
- The 2022 global outbreak saw higher transmission rates among men who have sex with men (MSM), but this represents a pattern of spread within a social network rather than the origin of the virus.
- The association with the gay community during the 2022 outbreak was due to epidemiological patterns of transmission within social networks rather than any inherent connection between the virus and sexual orientation.
- The CDC has provided guidelines for the prevention of bacterial sexually transmitted infections (STIs) in the MSM community, including the use of doxycycline postexposure prophylaxis (doxy PEP) 1.
- However, these guidelines are specific to bacterial STIs and do not address the transmission of viral diseases like mpox.
Transmission and Prevention
- Mpox can be prevented through avoidance of close physical contact with infected individuals, avoidance of contact with contaminated materials, and avoidance of respiratory droplets during prolonged face-to-face contact.
- The CDC recommends a comprehensive sexual health approach, including risk reduction counseling, STI screening and treatment, recommended vaccination and linkage to HIV PrEP, HIV care, or other services as appropriate 1.
- While doxy PEP is recommended for the prevention of bacterial STIs in certain populations, it is not effective against viral diseases like mpox.
From the Research
Association with Men who have Sex with Men (MSM) Community
- The current monkeypox outbreak has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) 2, 3, 4, 5, 6
- Studies have shown that a high percentage of monkeypox cases are among men who report male-to-male sexual or close intimate contact during the 3 weeks before symptom onset 4
- The outbreak has also disproportionately affected racial and ethnic minority groups, with higher incidence rates among non-Hispanic Black or African American and Hispanic or Latino males compared to non-Hispanic White males 6
Clinical Characteristics and Transmission
- Monkeypox cases in the current outbreak are less likely to have a prodrome and more likely to have genital involvement compared to historical reports of monkeypox in areas with endemic disease 4
- The virus can be transmitted through close contact with an infected person, including sexual contact, and can cause symptoms such as fever, headache, and rash 2, 3, 4, 5
- Atypical symptoms, such as anogenital lesions and proctitis, have been reported in the current outbreak, particularly among men who have sex with men and concomitant human immunodeficiency virus (HIV) disease 5
Vaccination and Prevention
- Vaccination against monkeypox is available and has been shown to provide protection against the disease, with a reduced risk of infection among vaccinated persons compared to unvaccinated persons 2
- Efforts to increase vaccination among racial and ethnic minority groups, particularly Black and Hispanic males, are needed to reduce the incidence of monkeypox and address disparities in vaccination rates 6
- Public health efforts should prioritize gay, bisexual, and other men who have sex with men for prevention and testing, while addressing equity, minimizing stigma, and maintaining vigilance for transmission in other populations 4