Men Having Sex With Men: Where Most Mpox Cases Come From

The report was released on Tuesday, August 13 covering multiple countries and assembling case-based data on outbreaks from national authorities as of June 30, 2024.

Men Having Sex With Men: Where Most Mpox Cases Come From
A photo of two men holding hands and illustration of the Mpox virus (inset). /PHOTO.WORLD HEALTH ORGANIZATION

It is now emerging that nine out of 10 cases of Mpox (formerly monkeypox) reported are men with most of the transmissions occurring through sexual contact, with the Democratic Republic of the Congo (DRC) in particular focus as the sexual transmission has been recorded among men who have sex with men.

A report by the World Health Organisation (WHO) revealed that out of 90,410 cases of Mpox, 87,189 of them were men, with 96 percent getting infected through sexual intercourse. Furthermore, the virus was reported in men aged between 29 and 41.

The report was released on Tuesday, August 13 covering multiple countries and assembling case-based data on outbreaks from national authorities as of June 30, 2024.

Globally, sexual contact is the most commonly reported mode of transmission of Mpox, with 19,102 of 22,801 cases reported, followed by person-to-person non-sexual contact.

Hands of a person infected with Mpox. /BUSINESS INSIDER

“This pattern has persisted over the last six months, with 97 percent of new cases reporting sexual contact. Among cases where at least one symptom is reported, genital rash was the most common symptom followed by fever and systemic rash,” the report explains in part.

With regards to DRC, which recorded more than 13,700 cases and 450 deaths since the beginning of the year, the virus has proven to be a formidable threat amongst sex workers and Men Who Have Sex with Men (MSM).

Meaning Of Men Who Have Sex with Men (MSM)

According to the Centers for Disease Control and Prevention (CDC), the national public health agency of the United States (US), MSM comprise a diverse group regarding behaviours, identities, and healthcare needs. The term is often used clinically to refer to sexual behaviour alone, regardless of sexual orientation (e.g., a person might identify as heterosexual but still be classified as MSM).

Sexual orientation is independent of gender identity, therefore the classification of MSM can vary in the inclusion of transgender men and women based on whether men are defined by sex at birth (i.e., transgender women included) or current gender identity (i.e., transgender men included). Therefore, sexual orientation as well as gender identity of individual persons and their sex partners should be obtained during health care visits.

The WHO report adds: “Sexual transmission has been recorded in the Democratic Republic of Congo among sex workers and men who have sex with men. Among cases exposed through sexual contact in the Democratic Republic of the Congo, some individuals present only with genital lesions, rather than the more typical extensive rash associated with the virus.”

The international health agency reported that sexual transmission of Mpox happened through oral and penetrative vaginal or anal sex with someone infectious. People who have sex with multiple or new partners are most at risk.

“Anyone with new and unusual rashes should avoid having sex or any other kind of close contact with other people until they have been tested for sexually transmitted infections (STIs) and Mpox. Remember that the rash can also be found in places that can be hard to see inside the body, including, the genitals area," the agency recommended.

WHO also recommended methods of reducing the risk of sexual infection by openly communicating with partners about Mpox symptoms and risks, informing sexual partners of any symptoms developed, taking a break from having sex, and reducing the number of new sexual partners, one-off sexual partners.

It also called for consistent use of condoms, avoiding group sex, avoiding sex-on-premises venues such as cruising bars, saunas and darkrooms, and avoiding using alcohol or drugs in sexual contexts.

“While the Mpox virus has been found in semen, it is currently not known whether it can be spread through semen or vaginal fluids.

“Wearing a condom won’t fully protect you from Mpox, but it may reduce your risk or extent of exposure and it will help protect you and others from HIV and a range of other STIs. People with Mpox are advised to use condoms for 12 weeks after they recover,” WHO adds.

Public Health Emergency

On the same day the report was released, the disease was declared a public health emergency by the Africa CDC. Kenya, despite reporting just a single case of Mpox, finds itself on high alert alongside several other African nations as the continent grapples with a rapidly spreading strain of the virus. 

The emergency declaration has shaken governments across Africa into action. The highly contagious disease, characterised by flu-like symptoms and pus-filled lesions, has spread beyond Congo's borders, affecting countries such as Burundi, the Central African Republic (CAR), Rwanda, and Kenya.

The Kenya-Uganda Busia One-Stop Border Post. /PHOTO

The public health emergency declaration is expected to galvanise government efforts across the continent, enabling better coordination in response strategies and potentially unlocking a crucial influx of medical supplies and humanitarian aid to the hardest-hit regions.

The declaration of a public health emergency is expected to facilitate better coordination of response efforts and potentially increase the flow of medical supplies and aid into affected areas. However, significant challenges remain.

Despite the urgent need for vaccines, the availability of doses is severely limited. Reports indicate that only 65,000 doses might be available for the entire region in the coming months, with vaccination campaigns unlikely to begin before October.

The spread of Mpox has been particularly alarming in Congo, where the country is battling what experts describe as a "severe outbreak." With over 14,000 cases and 511 deaths reported, the situation is dire, and the threat of the virus spilling over into neighbouring countries has become a reality.

This delay in vaccine distribution comes at a time when the WHO is considering following Africa CDC’s lead in declaring the outbreak a global emergency. However, even if such a declaration is made, the road to effective containment is fraught with obstacles, including limited vaccine supply, insufficient funding, and the presence of competing disease outbreaks across the continent.