Monkey pox. Why are gay and bisexual men most affected?

“The data collected show that 97% of those infected are homosexual men. What can explain this figure? », asks Hervé.

As of August 4, 2022, 2,423 confirmed cases of monkeypox have been identified in France. While this number continues to rise, the disease seems to hit men harder, and gay and bisexual men in particular. Is it possible to explain this phenomenon? West France answers you.

A new phenomenon

This is not the first monkeypox epidemic, but it is the first time that it has taken on such magnitude on the European continent. “In the epidemics that there have been so far, there has not been a sustained chain of human-to-human transmission. We were talking more about a micro-epidemic”says Pr. Pierre Tattevin, infectious disease specialist at the Rennes University Hospital, whom we interviewed.

Outside the African continent, “99% of the cases identified are men”Dr. Rosamund Lewis, the WHO’s leading expert on monkeypox, said on Wednesday July 20, 2022, and 98% of them are “men who have sex with men, and primarily those who have multiple recent partners, new or anonymous”.

These data are also new. “In previous epidemics, cases were shared between men and women”says Prof. Pierre Tattevin.

However, according to the sequences, the virus is not very different from that which can be observed in West Africa. “What is special is the population in which it spreads”notes the doctor.

Read also: Monkey pox. Symptoms, transmission, vaccination… Where is the epidemic?

The origin of the foci of contamination

There are several avenues to explain the overrepresentation of homosexual and bisexual men among those infected with monkeypox. First of all, it is possible that the epidemic foci originated within the homosexual community.

“The virus has spread within a community that has more partners, more exchanges, and this has undoubtedly allowed the virus to spread more quickly”explains Prof. Pierre Tattevin.

The multiplicity of sexual partners is the main factor of propagation, regardless of sexual orientation: “74% of informed cases declare having had more than two sexual partners in the three weeks before the onset of symptoms”can we read in The world.

“Sex is the perfect way to have prolonged contact, everything is in place so that the virus can pass from one person to another. And when you have several partners, you multiply the chances of catching the virus but also of spreading it. This is how the epidemic can progress so quickly”supports Professor Pierre Tattevin.

Other elements may have allowed the rapid spread of the disease among gay and bisexual men. The symptoms of the disease are not the same for everyone and can sometimes go unnoticed or be confused with another pathology. “The lesions are not necessarily characteristic, some pimples may rather look like herpes, for example. Some people may not have had the reflex to go to consult right away ”analyzes the doctor.

A sexually transmitted infection?

Human-to-human transmission occurs through prolonged face-to-face contact through respiratory droplets, or through direct contact with an infected person through bodily fluids, disease lesions, or internal mucous membranes. “Sexual intercourse […] meet these conditions for contamination, and having several partners increases the risk of being exposed to the virus.recalls Public Health France.

But then, can we consider this disease as a sexually transmitted infection (STI)? “It’s a very semantic debate. If we cut STI, it means sexually transmitted, so that can be transmitted sexually. So yes, indeed, it can be transmitted sexually, however it is not only that. Contamination can also take place through skin-to-skin contact outside of a sexual act, or through very prolonged proximity through the respiratory tract.highlighted Dr. Pierre Tattevin.

Read also: Monkey pox. Am I protected if I was vaccinated against smallpox before the 1980s?

How to protect yourself?

Condoms, although strongly recommended against STIs, are not enough to protect against monkeypox. “As these are transmissions that also occur from skin to skin, it is not because a person puts on a condom that they will not catch the disease. If people have lesions on their hands, buttocks, stomach… It will not protect”alerts the infectious disease specialist.

In addition to vaccination, which is recommended for people at risk, other reflexes must be adopted to avoid being contaminated. “It is a disease which can be painful, which can be painful. The most important thing today is to take precautions, not to have multiple partners for a few weeks. It will be much more effective than trying to vaccinate everyone.”insists Prof. Pierre Tattevin.

And everyone is affected by these recommendations. Asked by The world Yannick Simonin, lecturer at the University of Montpellier and specialist in emerging viruses, calls for “be careful not to stigmatize the homosexual community”: “Monkey pox does not only concern this community, even if the cases there are currently over-represented”.

What vaccines are available?

Two third generation vaccines against smallpox are available in France. These are Imvanex and Jynneos, produced by the Danish biotech company Bavarian Nordicet. They require two doses, separated by at least 28 days. It takes two weeks after the second injection for the vaccine to take effect.

Two other scenarios may exist. If you have been vaccinated against smallpox in the past, one dose is sufficient. For immunocompromised patients, three doses are recommended, regardless of whether they have been previously vaccinated or not.

Vaccination is free and appointments can be made on the Doctolib platform. The list of vaccination centers can be found on the santé.fr website.

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