Everything We Know (And Don’t Know) About How Monkeypox Spreads

The first human case of monkeypox was in 1970 in the Democratic Republic of the Congo. But despite it now being endemic in large parts of Central and West Africa – we don’t know much about this virus.

That’s starting to change, but only after an outbreak affecting the global north began in May 2022. Since then, experts have been racing to work out why the virus has been spreading between people. Particularly because it’s happening in a way not seen before.

“I’m asked a lot, ‘what happens if I’m on the dance floor’, or ‘if I’m in an airplane and someone’s got monkeypox – am I going to catch it?'” Professor Chole Orkin told the What The Pox? podcast by QueerAF.

“I’m asked: ‘Is it going to spread outside the sexually active gay/bi men’s community?’ ‘What if it spreads to women and children?'”

All these questions can be answered in one way: there isn’t much we do know.

“It’s a neglected infection. The doctors in Africa have been begging for help and sounding alarms that it’s been increasing. Both in the Democratic Republic of Congo and a large outbreak in Nigeria in 2020.

“Do we know anything about this disease? No. Why? Because it’s a disease that affected black bodies in Africa. There was very little market for drugs because governments in Africa couldn’t afford them.”

However, experts like Orkin, are changing that.

What do we know about the way monkeypox spreads?

Since the global north outbreak Orkin has led a massive research project.

It features case studies from all around the world to understand more about how the virus is transmitted. Thanks to this study we have an updated list of symptoms appearing in this outbreak, compared to previous ones.

“I looked at the map, and where the cases were and sent some emails. I went from person to person until I found people who had monkeypox. It got bigger and bigger until it was 16 countries, 43 sites and 528 people with the virus”

“The challenge was it was clearly spreading differently to what we’d seen previously.

“We were seeing things that aren’t listed, like throat problems, terrible sores in their mouth and anue – not being able go to the toilet. Being admitted for this, and needing surgical draining or even a catheter.”

One thing quickly became clear, sex was a major factor in the outbreak.

Is monkeypox a STI?

Monkeypox spreads primarily through skin-to-skin contact. And in Orkin’s research, that contact, in the majority of cases, was through sexual activity.

Yet, because the virus can pass between people without sex – she says “it isn’t what we’d traditionally call a sexually transmitted disesase.”

There is also some evidence of household transmission, though it usually only happens in a chain of a few people. That could be because of large droplets from coughs and sneezing, touching the infected lesions or from sharing ben linen or towels.

In Orkin’s study, the stats were clear – it was spreading within a dense sexual network.

“76-99% of cases are related to sexual closeness. People have got het up over whether it’s an STI or not. You can get it without having sex, so in that sense it’s not described as an STI.

“However nearly all of the cases [in her study] have been connceted with sexual closeness.”

How does monkeypox spread?

“The skin lesions are the most infectious,” Orkin explains on the What The Pox? podcast. “The best way the virus can have transmission is in skin-to-skin contact with infected legions.

Orkin’s study also found that the virus was in semen. She believes the virus could also be passed on through semen but notes that research still needs to be conducted to see if this is the case.

“There were five centers who tested semen and in a total of 32 people, we found it in 29 people – a high proportion. However, it being present is a different question to whether it’s infectious in semen. The virus has to be replication competent, to be able to infect another cell.

“But if you asked me what I think, I’d say it probably can be sexually transmitted via semen. I feel quite strongly about that. But regardless of whether it’s infecting people via semen, it is during sex that it’s transmitting because of the skin to skin contact”

Can monkeypox be transmitted though the air?

The professor also spoke about some evidence that suggests it could be passed via the air. Respiratory secretions through face-to-face interactions are also listed as a transmission point by the CDC.“If you measure the viral load (the amount of virus), in lesions to say respiratory secrections – they are much lower in respiatory, than on the skin,” Orkin explains.

So what can we be confident in when it comes to surfaces and the air?

“We know the virus can live on surfaces for up to 15 days, possibly longer depending on the surface. If someone is sick, and you’re changing their sheets and it goes in the air – you are at a risk of catching it.

“The point is, it’s about the amount of virus, and how high the infecting dose is – and when you have sex there is sustained amount of time rubbing skin. That’s different to rubbing against someone’s tshirt. “

Understand even more LGBTQIA+ news this week. Get QueerAF, my free weekly newsletter every Saturday, which also supports underrepresented queer creatives to build a media career. Quotes in this article were edited for clarity. What The Pox? is available in podcast apps.