What is monkeypox, what are the symptoms and why are gay and bisexual men at risk?

Monkeypox lesions

There has been much discussion in recent days about monkeypox, the rare viral infection that’s been detected in several countries around the world.

Since 6 May, there have been nine cases of monkeypox detected in the UK, with the country’s health security agency noting cases have predominantly been found in gay and bisexual men.

The UK isn’t alone – cases have been detected in Spain and Portugal, with outbreaks concentrated around Lisbon and Madrid. Over in the United States, the Massachusetts Department of Public Health has confirmed that a man who had recently travelled to Canada had picked up the virus.

Any mention of a virus doing the rounds naturally causes some level of panic – however, health authorities have been clear that monkeypox generally poses a low risk.

The reason it’s causing some level of worry among health officials is because monkeypox is rarely detected outside parts of Central and West Africa. Because many of the cases detected in the UK aren’t associated with travel, it appears that the virus is spreading through community transmission.

Naturally, people have a lot of questions about symptoms, treatment, exposure and prevalence.

What is monkeypox?

According to the World Health Organisation (WHO), monkeypox is a “viral zoonotic disease” that is usually found in parts of Central and West Africa, but is occasionally exported to other areas.

A “zoonotic disease” refers to a virus that’s passed from animals to humans. It has a number of similarities to smallpox, which was eradicated in 1980.

Assistant Scientist Sigrun Haugerud demonstrates how to prepare a test sample, the first step taken when testing for the monkeypox virus.

Assistant Scientist Sigrun Haugerud demonstrates how to prepare a test sample, the first step taken when testing for the monkeypox virus. (JUDY GRIESEDIECK/Star Tribune via Getty)

Monkeypox was first detected in humans in the Congo in 1970, when a nine-year-old boy was found to have the virus. Since then, the virus has been detected in numerous countries.

Nigeria has been dealing with an outbreak of monkeypox since 2017 – there have been more than 500 suspected cases and over 200 confirmed cases in the country. According to the WHO, the case fatality ratio is around 3 per cent.

Is monkeypox a sexually transmitted infection?

Much of the discussion about monkeypox in recent weeks has focused on the fact that it’s being detected among gay and bisexual men.

That has led many to think that monkeypox is a sexually transmitted infection, but that’s not the full picture. Dr Claire Dewsnap is president of the British Association for Sexual Health and HIV (BASHH) – she says it’s likely spread through close contact with infected skin.

“One thing that we don’t know for certain yet is whether the reason we’re seeing it in gay men is because they’re going to clinics,” Dr Dewsnap tells PinkNews. “It’s very common for a gay man who’s been sexually active with a new partner to think, ‘I’ve got a funny rash, it could be syphilis, it could be herpes, I’ll go to my clinic.’

“We need to be very careful to remember that it’s a virus that’s spread through close contact and the vast majority of monkeypox cases have been in the heterosexual community in Africa.”

According to the WHO, it is not yet known if monkeypox can be passed on directly through sex – the organisation says more studies are needed to understand the risk – but it’s likely that it’s simply passed on through close contact. Naturally, that means a person could still contract the virus while having sex with somebody who’s carrying it, but that doesn’t make it a sexually transmitted infection.

Is there a risk that the monkeypox conversation could stigmatise the LGBTQ+ community?

The misconception that monkeypox is an STI is already spreading rapidly, which can further stigmatise already affected communities. Dr Dewsnap says the notion is “potentially harmful”.

“As we know, talking about STIs is stigmatising, and that’s worse in some populations than others. It can be potentially harmful and it can prevent people from coming forward with symptoms because they can think that having an STI is something to be afraid or guilty of.”

Dr Dewsnap says it’s vital we challenge those misconceptions about monkeypox and the current outbreak in the UK and Europe.

“We don’t want the idea that this is an STI to stick because that certainly hasn’t been proven. We do know that this particular funny cluster of monkeypox has behaved unusually, differently than we would expect it to, but it hasn’t been identified as an STI and we shouldn’t see it that way.”

What symptoms should I be looking out for?

By all accounts, monkeypox is still extremely rare in the UK – just nine cases have been detected. However, as it appears those cases were the result of community transmission, authorities are urging people – particularly gay and bisexual men – to watch out for some key symptoms.

If you’ve recently developed unusual rashes or legion on any part of your body – especially the genitalia – you could have monkeypox, according to the UK Health Security Agency (UKHSA).

The WHO says the incubation period for monkeypox is usually six to 13 days, but it can range from five to 21 days. The infection is generally divided into two stages – the invasion period can last up to five days. At this stage, you might have a fever, a headache, swelling of the lymph nodes, aches and pains and a general lack of energy.

Between one and three days after the onset of fever, you might develop rashes or legions on your body. The WHO says symptoms could last from two to four weeks.

Why is monkeypox being detected among gay and bisexual men?

The UKHSA has said cases are primarily being detected among gay and bisexual men, which has led to some level of concern in the LGBTQ+ community.

It’s thought that monkeypox is not sexually transmitted, but it’s possible that the virus is spreading through close contact in sexual networks, according to Mateo Prochazka, an epidemiologist with the UKHSA.

On 17 May, Prochazka said on Twitter that 57 per cent of the cases they had detected at that stage were among gay or bisexual men. That figure is “highly suggestive of spread in sexual networks”, he said.

“Finding MPX cases that do not have travel links is rare, and suggestive of importation followed by some extent of community transmission. This situation is being rapidly assessed.

“What is even more bizarre is finding cases that appear to have acquired the infection via sexual contact – this is a novel route of transmission that will have implications for outbreak response and control,” Prochazka wrote.

Queer people will be all too aware that viruses that are prevalent in the LGBTQ+ community can quickly be used to stigmatise and marginalise. We’ve been there before with HIV, which is why it’s vital monkeypox isn’t used as a weapon against LGBTQ+ people.

What should I do if I think I have monkeypox?

If you’ve developed unusual rashes or lesions, or any other symptoms associated with monkeypox, you should seek assistance from local health authorities.

“If somebody’s been exposed from a sexual partner then what we’d recommend you do is ring your local sexual health clinic and get advice,” Dr Dewsnap says. “Most clinics have already begun to set up some specific triage systems for people who think they may have symptoms that are consistent with monkeypox.”

Dr Dewsnap says people who are worried can also contact their GP or call 111 for further advice. Those outside the UK should check what the local guidance is to determine how best to proceed.

Should I be worried about the outbreak?

The simple answer to this question is no – according to Dr Dewsnap, it’s highly unlikely people in the UK who contract monkeypox will become seriously sick.

“People will be anxious, especially after what we’ve been through over the last two years with COVID,” Dr Dewsnap says. “As a general rule, it’s very unlikely you’ll become unwell with monkeypox. The vast majority of people who get this have a small self-limiting viral illness and then have some lesions on the skin which eventually scab over and go away.”

She continues: “There is no danger in terms of your long term health, there are no major complications, and really the reason for the fuss around it is that it’s an imported infection, because traditionally we don’t have cases of monkeypox in the UK. I would say not to worry about it – if you do get it you’re going to be fine. You just need to seek the most appropriate healthcare advice if that happens.”

The monkeypox scare also goes to show just how important sexual health services are, Dr Dewsnap says – she says they should be adequately funded to make sure people can access the right supports.

“We need to call for better funding for sexual health services to make sure that the capacity is there for people when they need it.”