Monkeypox won’t remain an 'MSM disease' indefinitely, so let's stop treating it that way

The world is currently experiencing by far the largest ever epidemic of human monkeypox, and the United States is disproportionately affected, accounting for 16,500 of the 46,000 confirmed cases globally.  Monkeypox is a disease with a long incubation period, so it will take time to turn it around — we need to treat it with urgency, now.

We are at a pivot in this outbreak, similar to March 2020 for COVID-19. The best thing we can do right now for public health is to stop putting this disease into a box to which it doesn’t belong.

The monkeypox virus has — thus far — shown an uncanny ability to stay within certain social networks to which it has been introduced (men who have sex with men, or MSM). That said, monkeypox is not a “gay disease”, and we should not be treating it as such.

Monkeypox can spread between people in a number of different ways. One of the main ways this disease is transmitted in the current epidemic is skin-to-skin contact, including, but not exclusively, sex.

Monkeypox is not strictly a Sexually Transmitted Infection (STI), so it won’t remain in the same social networks indefinitely.  It can spread from hugs and handshakes.  The virus is also known to spread by contaminated surfaces (including bed linens), and by respiratory droplets (sneezing, cough, etc.).

While monkeypox may be STI-like in MSM populations right now, this tells us very little about how it will transmit more broadly.  We simply don’t understand these dynamics yet — consequently, we need to re-tune the way we’re talking about the disease in the public discourse.

The practice of treating monkeypox as an MSM disease can greatly exacerbate the epidemic. It will suppress care-seeking behavior among parents of small children, just as we’re approaching the start of the school year.  Other accounts detail awful delays in diagnosis, sometimes caused by clinicians pondering the patient profile.

The “it’s an MSM disease” drumbeat can also affect diagnosis rates among adults, particularly for people who have mild cases, perhaps with a single lesion.  In turn, this allows more spread, deepening the outbreak. 

With over 11,000 cases in the United States, and the potential for the virus to infect a variety of mammals, including household pets, the time to get the monkeypox genie back in the bottle is rapidly running out.  Any congregate living settings with shared facilities — including residential higher ed, correctional facilities, military bases, daycares, and any other setting in which people congregate, are all perfect settings monkeypox transmission.

Monkeypox is not an STD — anyone can get it.  We need to craft the public health response accordingly, or pay the price of a much larger epidemic in the end. Now is the time to plan for a severe epidemic, so as to be pleasantly surprised and relieved later.  The first step is to stop calling it an MSM disease.  We can’t stem this epidemic by artificially putting it in a box to which it doesn’t belong.

Andrew Lover is an epidemiologist and assistant professor of epidemiology at the University of Massachusetts, Amherst.  Contact him at alover@umass.ed. Andrew Noymer is an epidemiologist and associate professor of population health and disease prevention at the University of California, Irvine. Contact him at noymer@uci.edu