Dr George Christos

covid19 & other Infectious diseases

The European monkeypox (EMPX) is still predominately tied to men having sex with men

I must admit I am taken aback a bit in that with the world case numbers around 45,000, and the USA at 15,000 cases of EMPX that it would have sneaked out into the general community by now, but is has hardly done so (see data below) and may be more of a sexual disease than previously anticipated.

When I first googled monkeypox, it said that blisters are usually found on extremities like hands and the face but the EMPX seems to have sores and blisters predominately in the genitalia and anal regions. The most predominant means of spread of EMPX is still thought to be by direct contact of skin to skin so if the sores are on or around the genitals and anus, as seems to be the case, then it may require sex to be transmitted.

From the NSW Health Fact Sheet: “Monkeypox symptoms may include: rashes, pimple-like lesions or sores, particularly in areas that are hard to see such as the genitals, anus or buttocks…and on the face, arms and legs.” REF

The initial growth rates suggested aerosol spread but that is not consistent with the fact that 97% of all cases in the USA are still men. REF

data from the CDC USA.

Here are the reported symptoms. Ouch!

The CDC is also mainly concerned about gay and bisexual men being at the greatest risk.

click on image to read this article.

Although most cases in the USA seems to be concentrated around gay men, that is reportedly not the case in Africa but I am still unsure if this is due to the Nigerian monkeypox clade or the EMPXV. How could they distinguish between the two?

click on image to read this article.

In any case, I have been tracking the growth in monkeypox cases from the start in May 2022 and the growth rate is consistently slowing. The doubling time was 3 to 4 days initially and it lengthened to about 10 days a month ago and is now closer to 20 days in the world now, but still 10-11 days in the USA. It could be that gay men in the USA are more blasé about monkeypox and sex. So far nobody in the USA has died from the monkeypox virus although that can change if the virus gets into the wider community and children, and if animals (esp. pets) start to play a greater role in transmission.

the MPXV is spreading most rapidly in the USA and Brazil

Added 31 August 2022. The number of daily cases has also stabilized. This suggests mpx had hit a barrier. If it was airborne as first thought, it would have been into general (non gay community) by now. I think being in the genital/anus region may be more significant that we think.

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