How to Practice Safe sex During Monkeypox (mpox) Outbreak
A recent pox outbreak (previously known as monkeypox) has prompted researchers to investigate how the virus is transmitted. Once largely confined to Africa, mpox is similar to smallpox. As of June 17, 2022, over 2,520 cases have been reported in 37 countries where the virus was previously uncommon, according to the Centers for Disease Control and Prevention (CDC). In response to its expanded reach and to address the stigma associated with its African origins, the World Health Organization (WHO) is considering a name change for the virus.
This year, the majority of cases have been reported in the United Kingdom, primarily among men who have sex with men (MSM). It is crucial to recognize that this is the first significant outbreak of mpox predominantly affecting this group, but the virus can infect anyone, not just MSM.
Researchers suggest that the virus may spread through social gatherings, sexual activity, and close skin-to-skin contact. Infectious disease expert Dr Steven Gordon discusses the potential modes of transmission and emphasizes the importance of practising safe sex during outbreaks to reduce the spread of mpox.
The risk of mpox is not limited to sexually active individuals or men who have sex with men. Anyone who has close contact with an infected person or has multiple sexual partners is at risk.
During the 2022/2023 multi-country outbreak, most cases were reported among gay, bisexual, and other men who have sex with men. This group may be at higher risk if they engage in close contact or sexual activity with someone who is infected. Raising awareness within these communities is crucial for protection. If you are a man who has sex with men, be aware of your risk and take protective measures. Anyone with symptoms of mpox should seek medical advice promptly for testing and treatment.
Sex workers and their clients are also at risk. Engaging with sex worker organizations to raise awareness and ensure protection is vital for preventing mpox outbreaks.
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What Are the Symptoms of Mpox?
In Australia and Europe, mpox symptoms can include skin lesions, sores, or a rash, along with fever, headache, fatigue, and swollen lymph nodes.
The rash, lesions, or sores may appear in less visible areas such as the genitals, anus, or mouth, as well as on the face, arms, chest, back, and legs. They can vary in appearance, resembling pimples, blisters, or even conditions like herpes or syphilis.
Symptoms typically develop within 1-2 weeks, but the incubation period can be up to 21 days. People may experience some or all of these symptoms. While most individuals will develop a rash, others might experience sores before flu-like symptoms or may not exhibit flu-like symptoms at all.
How is Mpox Transmitted?
Mpox is primarily transmitted through close physical contact with someone who is showing symptoms of the virus. This includes contact with skin rashes, lesions, or sores. The virus can spread through bodily fluids such as fluid, pus, or blood from these skin lesions, as well as through scabs.
Ulcers or lesions in the mouth can transmit the virus through kissing, while those in and around the anal area can be spread through intimate contact. Additionally, mpox can be contracted from clothing, linens, or objects that have come into contact with an infected person.
Respiratory transmission is also possible if an infected individual coughs or sneezes, releasing droplets that can be inhaled. Sexual activity can transmit the virus, though the duration that mpox remains in semen and other genital excretions is not well understood.
Therefore, individuals who have recovered from mpox are advised to use condoms for at least eight weeks after their recovery to minimize the risk of spreading the virus.
How to Protect Your Sexual Health
Mpox can spread from the onset of symptoms until all sores, including scabs, are completely healed. This healing process can take several weeks. To minimize the risk of spreading the infection, it is crucial to avoid skin-to-skin contact during this period.
If you are feeling unwell or have any rashes or open sores, avoid attending large social gatherings and stay away from small, enclosed spaces like locker rooms and saunas where infections can spread easily.
If you or your partner have Mpox, or if you are sick with rashes or open wounds, it is advisable to abstain from sexual activity and to sleep in separate beds until the infection is fully resolved. However, if abstinence is not possible, follow these guidelines recommended by the CDC:
Engage in virtual sex instead of in-person contact.
Practice mutual masturbation while maintaining a distance of at least 6 feet, avoiding contact with each other’s rashes or sores.
Use condoms or dental dams during sexual activity.
Wear clothing or cover areas with rashes or sores during sex.
Avoid kissing.
Wash your hands, sex accessories, and any fabrics such as bedding, towels, and clothing after sexual activity.
Limit the number of sexual partners to reduce the risk of further infection.
Why Are Mpox Cases More Common Among Gay, Bisexual, and Men Who Have Sex with Men?
Recent data indicates that a significant number of mpox cases are being identified among gay, bisexual, and men who have sex with men. One reason for this trend is that these groups often seek regular health check-ups and are proactive about sexual health. Mpox rashes can resemble symptoms of other sexually transmitted infections (STIs) like herpes or syphilis, leading to increased detection in sexual health clinics worldwide.
However, it is important to emphasize that mpox is not limited to any specific group. The virus can affect anyone who has close contact with an infected person.
Stigmatizing individuals based on their sexual orientation or health status is harmful and unacceptable. Mpox can affect anyone, regardless of their sexuality, and it is crucial to address the disease with understanding and respect for all individuals.
Mpox and HIV: Important Information for Those Affected
Current data shows that individuals with HIV are more frequently represented among mpox cases. While it is not yet clear if having HIV increases the risk of contracting the monkeypox virus (MPXV) upon exposure, we do know that people with advanced HIV (those who are immunocompromised) face a higher risk of severe mpox and potentially death if they contract the virus.
If you have HIV, you should follow the same preventive measures as everyone else to protect yourself from mpox. This includes getting vaccinated. It is crucial to take your HIV medication as prescribed and maintain an undetectable viral load, which helps you stay healthy and prevents the transmission of HIV to your HIV-negative partner.
Mpox Vaccines and People with HIV
The JYNNEOS vaccine, which requires two doses, is authorized for preventing mpox and is deemed safe and effective for individuals with HIV. This is the vaccine currently available in the United States.
Mpox and HIV: What to Know if You Contract Mpox
Limited evidence suggests that individuals with HIV, particularly those with low CD4 counts (fewer than 350 cells/ml) or who are not virally suppressed, may be more likely to experience severe illness or hospitalization from mpox compared to those without HIV.
Mpox treatments are generally safe and can be used for those at higher risk of severe illness. If you have HIV, consult your healthcare provider about the most appropriate treatment options for you.
Based on current knowledge, mpox treatments have minimal interactions with HIV medications. Be sure to inform your healthcare provider about your HIV status before starting any mpox treatment.
HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) remain effective in preventing HIV, even if you have mpox or are undergoing treatment for it. If you have been prescribed PrEP or PEP, continue taking your medication as directed.
What to Do If You’ve Been in Contact with Someone Who Has Mpox
If you or someone you know starts showing symptoms of mpox, or if you develop an unexplained rash or sores, it is important to contact your healthcare provider as soon as possible for a diagnosis.
In the meantime, to minimize the risk of spreading the infection, you should maintain a distance of at least 6 feet from others and wear protective clothing that covers any rashes or open sores.
If you had close, intimate contact with someone who has mpox within the past week, it is advisable to inform them of your symptoms. This allows them to seek medical advice and take appropriate precautions to protect their health.
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