WHO Advises Condom Use as Monkeypox is Detected in Semen
Men queing for the monkeypox vaccine in Chicago in the US.

Although it is not yet entirely clear whether monkeypox is sexually transmitted, the World Health Organization (WHO) has advised those at risk to use condoms during sex as monkeypox DNA has now been detected in semen.

“There have definitely been reports of the detection of the monkeypox virus DNA in semen,” Dr Rosamund Lewis, the WHO’s lead on monkeypox, told a media briefing on Wednesday.

“Monkeypox can be transmitted through the close contact that is involved in sexual activity and there may be a contribution to infection through contact with semen itself, but we don’t fully know the answers to this question yet.”

As a result, Lewis said, the WHO recommends the use of condoms “as a precautionary measure because we don’t know how much of the infection is transmitted through semen, but it is also because it reduces skin-to-skin contact”.

“It’s preferable to avoid skin-to-skin contact altogether if someone has monkeypox, but at the very least, using a condom may reduce that risk while we do more studies to learn more,” she added. “This applies to bisexual and gay men who have sex with men and anyone who has multiple sexual partners.”

Lewis added that there had been no reports yet of monkeypox transmission through blood transfusions.

Increased of cases in Americas

Over 50,000 monkeypox cases have been confirmed globally, and WHO Director-General Dr Tedros Adhanom Ghebreyesus told the briefing that the Americas account for more than half of reported cases. Cases were increasing cases in “several countries” in the region with the exception of Canada where there was “a sustained downward trend”.

“Some European countries, including Germany and the Netherlands, are also seeing a clear slowing of the outbreak demonstrating the effectiveness of public health interventions and community engagement to track infections and prevent transmission,” added Tedros. 

“With the right measures, this is an outbreak that can be stopped and in regions that do not have animal-to-human transmission, this is a virus that can be eliminated.”

“We might be living with COVID-19 for the foreseeable future. But we don’t have to live with monkeypox.”

Sexual transmission via semen?

Earlier in this month, Italian researchers reported in The Lancet that they had found monkeypox DNA in the semen of a 39-year-old patient living with HIV who self-identified as a man who has sex with men, and a sex worker. He had reported condomless sex with several male partners in the month before infection.

“Overall, our findings support that prolonged shedding of monkeypox virus DNA can occur in the semen of infected patients for weeks after symptoms onset, and show that semen collected in the acute phase of infection (day six after symptom onset) might contain a replication-competent virus and represent a potential source of infection,” according to the researchers, from the National Institute for Infectious Diseases in Italy.

“Whether infectious monkeypox virus found in semen could be associated with seminal cells or if viral replication occurs in the genital tract remains to be established,” they note.

However, they add that “the isolation of live replication-competent monkeypox virus from semen, and prolonged viral DNA shedding, even at low viral copies, might hint at a possible genital reservoir”. 

Dr Dimie Ogoina

Nigerian physician Dr Dimie Ogoina from the Niger Delta University, has previously raised the possibility of both sexual transmission of monkeypox and whether it could be transmitted by asymptomatic people.

“Monkeypox manifests in rashes. Would a person still engage in sex with these rashes? We need to look at asymptomatic transmission,” said Ogoina at a WHO meeting in June called to look at the new outbreak.

Ogoina was the first to raise the alarm about a monkeypox outbreak in Nigeria in 2017, which has been linked to the current global outbreak.

Writing about that outbreak in PlosOne, Ogoina and colleagues noted that “a substantial number of our cases who were young adults in their reproductive age presenting with genital ulcers, as well as concomitant syphilis and HIV infection”. 

Ogoina later told NPR that a sexual history assessment of patients in the 2017 outbreak found that many had multiple sexual partners and sex with sex workers.

“Although the role of sexual transmission of human monkeypox is not established, sexual transmission is plausible in some of these patients through close skin to skin contact during sexual intercourse or by transmission via genital secretions,” Ogoina and colleagues noted in the Plos One article, calling for further studies on role of genital secretions in transmission of human monkeypox. 

They also noted that HIV-infection might negatively influence the morbidity of human monkeypox “as patients with HIV had more severe skin lesions associated with genital ulcers” than HIV-negative individuals

Reducing number of sexual partners

“Protecting oneself involves the actions we’ve been talking about from the beginning, which are: reducing physical contact with anyone who has monkeypox, reducing the number of sexual partners, reducing casual sex or new partners and being more open about one’s risks and having conversations with others that may highlight mutual protection and protection of each other,” Lewis stressed. 

“This is not a disease that is limited to a specific group. What is happening is that it is being spread primarily in one risk group. We know that the majority of cases are occurring among bisexual men who are gay or bisexual. However, physical contact of any kind with anyone who has monkeypox would put someone at risk”. 

 

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