Monkeypox is ‘not an STD in the classic sense’

The Centers for Disease Control and Prevention (CDC) is encouraging people to take extra precautions as monkeypox has been detected in over 1,000 people across 29 countries. Major LGBTQ organizations are warning their communities of a greater risk for exposure because of increased numbers of large gatherings during LGBTQ Pride month. 

According to Northwestern Medicine infectious diseases expert Dr. Robert L. Murphy, over 95% of cases in Europe, Canada and the U.S. are in LGBTQ individuals, specifically hitting the community of men having sex with men (MSM). While Murphy said monkeypox is “not a sexually transmitted disease in the classic sense” in that it’s not spread through semen or via sex, it is behaving similarly to one by affecting individuals who have had close physical contact.  

But blaming gay men for spreading monkeypox will harm everyone, said Steven Thrasher, the inaugural Daniel H. Renberg chair of social justice reporting and a professor at Northwestern University’s Medill School of Journalism, Media, Integrated Marketing Communications and the Institute for Sexual and Gender Minority Health and Wellbeing. 

Murphy is the executive director for the Havey Institute for Global Health at Northwestern University Feinberg School of Medicine and a professor of infectious diseases at Feinberg.  

He and Thrasher answer questions about the disease in the Q&A below: 

For interviews, please contact Win Reynolds (win.reynolds@northwestern.edu). 

Have we seen outbreaks of monkeypox before? 

Murphy: Yes. It was discovered in 1958, and the first human case was in 1970. There was an outbreak in the U.S. that came from imported animals from Ghana of 47 people in 2003. It was from imported animals that gave it to prairie dogs. What’s different now is that there are no more animals involved — humans have become the reservoir.  

How much bigger will the outbreak become? 

Murphy: The U.S. just purchased 36,000 more monkeypox vaccine doses, which implies the CDC is really concerned. These cases are popping up all over 29 countries. That being said, infectious disease people like myself are calling it an outbreak; it’s not an epidemic, and it’s very unlikely to become one. It’s a DNA virus, they don’t mutate like these RNA viruses, so you’re not expecting this to turn into something like HIV or COVID-19. 

The CDC knows how to handle it, but so far, it’s not happening, which is a big concern. This technically should be a very easy outbreak to control because we already have a vaccine and multiple treatment options. 

How can the U.S. control this outbreak? 

Murphy: I think it’s going to be very similar to what happened a few years ago with the meningitis outbreak in the gay community. Health care providers determined meningitis was spreading among MSM in Chicago, especially concentrated in areas where MSM lived and went out. They started vaccinating sexual- minority men on the north side of Chicago, for example, and other areas where the cases were popping up, but they had sites pinpointed in tents on the streets in Boystown, and I think that’s what’s going to have to happen here when they get the delivery of monkeypox vaccines. 

Thrasher: There are specific things LGBTQ medical providers and organizations can do. On the medical side, health care providers for MSM can get their patients vaccinated for hMPXV. Personally, I have had a positive experience with this kind of scenario. In 2013, I lived in New York City and had a gay doctor, and when I went in for a routine checkup, he asked me if I would consider getting a meningitis vaccine and explained that I should consider doing so because meningitis was moving through gay men in the community. I took the vaccine.  

At the same time, health care professionals were also going to sex clubs administering the meningitis vaccines. It worked; the outbreak was contained that year, without spilling over into a wider population. Of course, for medical providers or sex clubs to be able to offer this service, they need vaccines. And that’s where LGBTQ organizations come in. This is LGBTQ Pride month, and there are many large gatherings happening. LGBTQ organizations can warn their networks about symptoms, and they can record contact information for contact tracing for hMPXV (and also for COVID-19, which is still at an elevated level of community transmission around the country).  

Some LGBTQ groups are already doing this. But importantly, these organizations have relationships with elected officials. And right now, it is a matter of life or death that they utilize these relationships. They must get their elected allies to pressure the CDC and local health departments to get vaccines where they need to go and to allocate resources to market and distribute them in a targeted manner. An ad hoc approach of MSM asking to get vaccines can only have a limited effect; but a coordinated, targeted vaccine campaign towards MSM backed by state resources is necessary right now and could be highly effective. 

Why is monkeypox spreading among MSM? 

Murphy: Monkeypox is not a sexually transmitted disease in the classic sense (by which it’s spread in the semen or vaginal fluids) but it is spread by close physical contact with lesions. I go back to the example with meningitis. It’s not a gay disease — there have been outbreaks on many college campuses. But when you think about vaccinating, you want to look at high-risk populations first. So the CDC and local health departments will want to prevent and treat monkeypox in locations that are already experiencing or are predicted to experience an outbreak. 

What symptoms should people look out for? 

Murphy: Flu-like symptoms, fever, aches, fatigue, swollen lymph nodes and this rash that has a uniform, blistery appearance — unlike chickenpox, which might have lesions in all different stages (new little ones, old ones). It’s how you distinguish chickenpox from smallpox (monkeypox presents more like smallpox). If you spot any of these symptoms, seek immediate treatment.