Sex, ‘casual contact’ and pimples: a guide to separating monkeypox fact from fiction

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With local, state and national officials declaring emergencies over the monkeypox outbreak and a vaccine race leading to long lines — and waits — in many U.S. cities, the latest updates on the rare virus can be overwhelming and, well, confusing. appear.

But experts say it’s important to remember that monkeypox is a known disease that is rarely fatal (unlike the coronavirus) and already has an approved vaccine and treatment.

That’s not to say there aren’t real concerns about the outbreak, including a shortage of vaccines, rapidly rising infections and the fact that one community — men who have sex with men — is most at risk.

The first step in tackling this virus is education, experts say, so that people can better understand their risks, how the disease spreads and how to prevent transmission.

Can only gay or bisexual men get monkey pox?

No. While the outbreak is mainly spreading among gay and bisexual men, as well as some transgender and non-binary people, anyone — regardless of gender or sexual orientation — can become infected.

“No single person or community is responsible for the spread of a virus,” said Dr. Tomás Aragón, California public health director. “Monkeypox can affect anyone, and it spreads through skin-to-skin contact, as well as sharing items such as clothing, bedding, and towels.”

dr. Stuart Burstin, the interim national director of infectious diseases for the AIDS Healthcare Foundation, said it was “a coincidence” that monkeypox first infected men who have sex with men. The virus has spread further in that group, because transmission can easily take place during sexual encounters.

Of the more than 400 confirmed and suspected cases of monkey pox in Los Angeles County, 99% were in men, about 90% of whom were identified as LGBTQ, according to data from the Department of Health. Similar demographics from state and national health officials have found the same trend, and for that reason gay and bisexual men, as well as some other gay people, remain at the highest risk.

“The risk to the general public is low, but there is a chance — and I would predict — this virus will enter the general public,” Burstin said. In very rare cases, it has already happened: At least five children in the US and one pregnant woman have been infected, according to health officials.

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How does monkeypox spread?

Monkeypox spreads primarily through close skin-to-skin contact, but it can also be passed through infected sheets or towels or through “respiratory secretions,” according to the Centers for Disease Control and Prevention.

Intimate contact should include direct and usually long-term interaction with an infected ulcer, rash or lesion, but Burstin said such markings aren’t always obvious, especially at the beginning of an infection.

“It’s possible for someone to have early illness that looks like a pimple or something in the anus that you can’t see,” Burstin said.

There is no evidence that monkeypox, like the coronavirus, can spread through shared airspace, experts say.

“I think it’s very important that people recognize that monkeypox is not like COVID,” said Aragón. “[Monkeypox] is very different in terms of transmission; you have to have really close, physical contact.”

What are the typical symptoms?

dr. Leo Moore, director of clinical services for the Los Angeles County Department of Public Health, said people with monkeypox typically develop a flu-like illness, including fever, fatigue, muscle aches and enlarged lymph nodes. Those symptoms are then followed by a rash.

“In many cases, people with the current outbreak develop a rash with or without swollen lymph nodes that can also appear in the genital area or anal area,” Moore said. “We also see that the rash occurs all over the body, including on the face.”

He said people usually develop symptoms a week or two after being exposed, but it can take up to 21 days for the virus to be detected and symptoms can last up to four weeks.

“The rash doesn’t look exactly the same on everyone,” said Barbara Ferrer, LA County director of public health. That’s why it’s important to check yourself and get tested if something looks irregular, she said.

Symptoms are usually mild, although lesions can become quite painful for some patients, Moore said. No one has died from monkey pox in California, but at least 14 people have been hospitalized for the disease.

Who can get a vaccine or treatment?

The Jynneos two-dose vaccine series, which has been approved by the Food and Drug Administration for monkeypox, can be used preventively and within two weeks of exposure. But doses are currently limited, prompting health officials to establish eligibility requirements so those most at risk for infection can get the first available injections.

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In Los Angeles County, officials recently expanded eligibility, but the focus is still only on those directly exposed or gay, bisexual and transgender men who meet certain criteria, such as having multiple recent sex partners.

As for treatment, health experts say most patients can recover on their own, but there is one antiviral drug — tecovirimat, also known as Tpoxx — that can be administered to relieve symptoms. However, many health care providers have struggled to access Tpoxx, which is only recommended for use in severe cases or for those with certain high-risk health factors. CDC officials have said they are working to streamline the process so that more people can access the drug.

As of this week, the California Public Health Department said 1,144 TPOXX courses have been delivered and are ready for use at 71 locations across the state.

Can monkeypox spread? asymptomatic?

“It doesn’t appear at this point that there is any risk of asymptomatic spread,” said Dr. Jay Gladstein, the medical director of APLA Health, an LA group focused on providing health care to the LGBTQ community. .

While this outbreak is still under study, Gladstein said transmission has so far only been linked to contact with virus-filled lesions.

But people need to know that the virus can be spread until lesions are completely healed and covered with a new layer of skin, which can take weeks.

Are massage therapists or tattooists a risk?

Burstin said the risk remains very low for people who work in industries that come into contact with the skin, but he said it’s important to check for rashes or bumps.

“Security is really, really high,” Burstin said. “If you don’t see a lesion, it’s much more likely that the person isn’t contagious.”

He said it is extra safe that professionals should wear gloves and increase cleaning protocols, but he did not recommend drastically changing operations.

“The skin lesions are visible and for the people who have them, they’re painful, so hopefully people will notice,” Gladstein said. He said there have been no outbreaks among health professionals caring for patients with active monkeypox.

Should gyms, bars, swimming pools or public transport be a concern?

“What we don’t see is an accidental spread. It has to be really close contact,” Gladstein said. “The risk will be vanishingly low, close to zero.”

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Moore said there are certain precautions people can take in crowded spaces, such as wearing long sleeves and pants to limit skin-to-skin contact. He recommended wiping down equipment at the gym and washing your hands. But surface contact and short-term interactions are not how monkeypox is transmitted, experts say.

As for pools, Burstin said he’s not worried given the chlorine and how everything in the water would be diluted.

He said there are scenarios, such as being in a club with a gay men’s event where many people could be shirtless, that he would consider more risky. But most everyday interactions shouldn’t involve people. He said he wouldn’t worry about brushing someone’s arm in a bar or on public transport.

“This type of contact disease usually isn’t transmitted that quickly,” Burstin said.

Can using condoms prevent the spread?

Unfortunately, condoms aren’t a surefire way to prevent monkey pox, but they can be protective, experts say. Researchers noted in this outbreak that many patients’ lesions focused on the genitals or anus — in which case a condom could provide protection — but just as many have reported infectious lesions elsewhere on the body.

“A condom won’t be perfectly protective,” Burstin said. “That doesn’t mean people shouldn’t wear condoms; it can provide a degree of protection.”

Monkeypox is not considered a sexually transmitted disease, but researchers are still trying to determine whether it can spread through semen or vaginal fluids. Some studies have shown that possibility, so experts also recommend using a condom for a few weeks after recovering from the virus.

Does the smallpox vaccine protect?

Adults who may have received a smallpox vaccine may have some protection against monkeypox, but experts say it is very limited.

“There is no significant protection as far as we know,” Gladstein said. “They may end up with a slightly milder form of monkey pox, but it’s certainly not considered fully protective.”

As with all vaccines, he said, protection wears off over time, and with the US smallpox vaccine campaign ending in the 1970s, no one should rely on that inoculation.

People who have received the smallpox vaccine are eligible for the Jynneos injection.

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