Just last week, health minister Dr Joe Phaahla confirmed the first case of monkeypox in Mzansi, and in the aftermath of a devastating Covid-19 pandemic, people are worried. The current circulating strain of monkeypox is mostly not fatal, and is transmitted through close personal contact for example skin-to-skin contact, says Professor Derseree Archary.
Archary is a mucosal immunologist and senior scientist at the Centre of the AIDS Programme of Research in South Africa (CAPRISA).
Monkeypox is a virus that causes pus-filled blisters, and has been detected in several countries, including the United States, Canada, Australia, some European countries, and more recently South Africa.
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Why does it appear that monkeypox is more prevalent among men who have sex with men?
According to the National Institute of Incommunicable Diseases, to date, reported cases have mostly involved individuals who identify as men who have sex with men (MSM).
Dr Jo Barnes, a senior lecturer in epidemiology and community health at Stellenbosch University, tells Health For Mzansi that it has been posited in several publications that monkeypox was predominantly detected in MSMs due to recent festivities and travel that occurred in Europe.
“These raves were attended by people from all over the world. One or more persons who attended these raves were/were infected and the disease spread from there. The international visitors took the disease back to their own countries, that is why it spread so far and wide so quickly.”
How is monkeypox transmitted from person to person?
Archary clarifies that monkeypox is transmitted through close personal contact, more specifically skin-to-skin contact, body fluid exchange from kissing for example, from respiratory droplets of an infected person and, coming into contact with the clothes or bed linen of infected individuals.
“Monkeypox virus is a DNA virus, belongs to the genus *Orthopoxviridae and is part of the poxvirus family. Smallpox and cowpox are part of this family of viruses too. Two clades of monkeypox are endemic to Central and West Africa,” explains Archary.
How do we handle the risk of stigma in the spread of monkeypox? How is it spread in gay men and men who have sex with men?
Awareness is key in fighting stigma that may arise against gay men in township communities, says Barnes.
This current circulating clade of monkeypox has a death rate of less than 1%, this is the West African strain says, Barnes. “It [monkeypox] is not nearly as infectious as Covid-19 and the death rate of the strain, spreading at present, is very low.”
Archary says that there currently are studies being conducted to understand what the transmission dynamics are during sexual intercourse, explains Archary.
“Monkeypox cases are dominant in the MSM populations currently worldwide but this does not preclude spread to other close contacts who are not sexual partners,” she says. “I think we must be very cautious around the messaging and association that this is in MSM and bisexual men for two reasons: Firstly, likely misinterpretation by the lay public, and the stigma that this association can bring along with it for this already marginalised group.”
Is there a vaccine for monkeypox?
Older people who have been vaccinated against smallpox in their youth have partial immunity against monkeypox, says Barnes. The smallpox vaccine was discontinued in 1982, she adds.
“There is a vaccine against monkeypox, but there are only a small number of doses available in the world and they are mostly used for medical staff who are in close contact with such patients.”
Do condoms reduce the risk of contracting monkeypox?
Monkeypox is not specifically a sexually transmitted disease but is likely transmitted during sexual intercourse through a combination of close skin-to-skin contact and body fluid exchange, explains Archary.
She tells Health For Mzansi that condoms will not likely be completely protective against acquiring monkeypox, as during sexual intercourse there is a lot of skin to skin contact and fluid exchange through kissing.
“We do not yet understand if monkeypox is also spread through other fluids like vaginal or seminal fluids. Currently, some studies are being pursued to understand what the transmission dynamics are in the context of sexual intercourse and we await those results.”
How is it treated?
Monkeypox viral infections are generally self-limited, and would normally resolve within 2 – 4 weeks of the onset of symptoms, says Archary. “The incubation period is anywhere between 5 – 21 days,” she says.
“If monkeypox causes severe illness, there is an antiviral that was developed in the USA for treatment of smallpox called Tecovirimat. Tecovirimat is FDA-approved drug that is currently not widely available and according to the WHO has been licensed by the European Medicines Agency (EMA) for monkeypox in 2022.”