Stanford monkeypox case not sex-related, raising questions about transmission

A monkeypox case reported in the Bay Area adds to the growing evidence that people can contract the virus in multiple ways — and raises questions about just how easy it is to get infected during casual encounters with others.

A case investigation released on Tuesday by the Centers for Disease Control reveals that a man in his 20s who sought care at Stanford Hospital tested positive for monkeypox even though he hadn’t recently engaged in sexual activity. Epidemiologists have long thought the virus is primarily being transmitted through close skin-to-skin contact.

The case also highlights the trajectory of the virus and whether it could make a jump from the LGBTQ community — which has been disproportionately affected by the virus — to the broader population via public spaces. Though it is not the first time a case has been reported that didn’t involve sexual contact — two toddlers in the state have tested positive — the CDC report offers an in-depth look into what sort of activities the Stanford man was doing before he contracted monkeypox.

“There’s been concern from the very beginning: Do we really know about other means of transmission besides intimate contact?” asked John Swartzberg, an epidemiologist from UC Berkeley. “This case reinforces that this virus can transmit in other ways.”

According to the CDC report, the man started developing monkeypox lesions on his body roughly two weeks after he attended four crowded outdoor gatherings in the United Kingdom. The man told case investigators that the events involved dancing, that many people were wearing sleeveless t-shirts and shorts, and that the gathering was not exclusively for the LGBTQ community.

Nobody had any lesions at the event, the man said, and nobody appeared ill. The man also traveled on crowded trains and took two flights back to the U.S. Lesions appeared on the man’s hands, lips, chest and back, but none were reported on or near his penis. Symptoms went away almost a month after lesions first appeared.

The report states that fomites — inanimate objects that can transmit a virus, like sheets or doorknobs — may be a vector in which monkeypox can spread but requires further investigation.

For his part, Swartzberg said that there simply isn’t enough data out there to get a conclusive sense of whether the virus is transmitted through fomites or even other ways, such as respiratory droplets, which tend to spread about six feet before landing on the ground. Researchers are also investigating whether monkeypox is spread through semen.

Despite the case being an anomaly at the moment in terms of transmission, Swartzberg said it shouldn’t raise major alarm bells for the general public.

“I would not worry about going into a grocery story and somebody next to me having monkeypox,” he said. “This one case, I don’t think it changes how we conduct our daily lives.”

Art Reingold, another epidemiologist at UC Berkeley, said he wasn’t surprised by the report.

“I think one could have predicted we’d see some cases like this,” he said. “We knew that there were going to be cases of non-sexual transmission.”

In a statement, Santa Clara County’s health department said it wouldn’t comment on specific patients but said, “It is possible, but far more rare, to get monkeypox through contact with respiratory secretions and shared surfaces such as clothes, towels, or bedding.”

The Stanford incident comes as cases across the Bay Area continue to tick upwards. The Bay Area is currently reporting 921 cases, with San Francisco clocking in the highest number at 600. Santa Clara County has 106 cases, Alameda 132, San Mateo 31, Contra Costa 41 and Marin 11.

On Wednesday, Santa Clara County announced that it was following new federal guidelines from last week that help stretch the limited supply of monkeypox vaccine, known as JYNNEOS. Previously, health officials were utilizing a shot for each person; the recent recommendation now allows for a single dose to be shared among five people.