That doesn’t mean the virus is sexually transmitted, but officials say it shows that prolonged skin-to-skin contact is one of the main ways monkeypox is now spreading.
As of Monday evening, data from the US Centers for Disease Control and Prevention showed 1,972 probable or confirmed cases of monkeypox in the US.
Right now, the risk of monkeypox is low, according to the CDC, but public health experts say there are still things you can do to protect yourself, especially if you’re among those at higher risk.
Here’s what you need to know.
How monkeypox is spread
Symptoms usually begin within three weeks of exposure to the monkeypox virus and last two to four weeks.
The virus usually causes a rash with lesions that can be extremely painful. The pain may even be enough to send some people to the hospital, but this seems to be rare.
The rash often starts on the face and spreads to other parts of the body, the CDC says. Some people will also have a fever at first.
A person with monkeypox can pass the virus on to others at any time until the rash has healed, crusted over, and there is a new layer of skin over the affected area.
The virus is primarily transmitted through close physical skin-to-skin contact, but it can also be spread when you touch items such as sheets or towels that may have been used by someone with monkeypox, and through close face-to-face interactions such as kissing.
This hearth is a little different
The latest outbreak looks a little different, according to Dr. Demetre Daskalakis, director of the CDC’s Division of HIV/AIDS Prevention.
Monkeypox is not considered a sexually transmitted disease, but most people who have contracted it in the U.S. recently report some level of sexual activity, he said Monday. This can include penetrative encounters as well as oral sex.
“Some people have had a rash all over their body or different parts of their body, but there are many who present with genital and anal lesions as the first sign of illness,” Daskalakis said. “It kind of speaks to that close sustained contact.”
The virus could theoretically be transmitted through respiratory droplets, he said, but the CDC doesn’t see that happening in this outbreak.
“I can’t prove how effective it is. It doesn’t seem to be very effective. So it’s more skin-to-skin contact, more than face-to-face contact.
“But in the harm reduction discussion, it’s really important to say what we know and what we don’t know,” Daskalakis said. “It’s just important that people know that it’s not impossible to transmit monkeypox in this way so that they can really adjust their behavior as needed.”
Parties vs bars
Scientists are still studying how monkeypox spreads in this outbreak, but they say people don’t seem to get sick after, say, walking past someone or hugging them and walking past a lesion on their skin.
“If it’s a hug that doesn’t necessarily involve a shirt, there’s a theoretical risk of transmission, but that’s not what we’re hearing in terms of what’s happening with our cases, so the risk is lower.” I can’t say it’s zero risk,” Daskalakis said.
Rather, longer contact appears to be responsible for most cases now. “If you ask me how long is ‘long,’ I can’t answer that question, but it seems like it might not be transmitted by a light brush,” Daskalaskis said.
A ring party, a large dance party that can attract thousands of men and last all night or a weekend, can be one way to spread the virus. Dancing shirtless at a party that has good ventilation without interacting with someone who has visible lesions is probably low risk. If there’s an after-party that leads to sex, it’s much riskier.
In enclosed spaces, such as back rooms, saunas or sex clubs, or at sex parties, where there is often anonymous contact with multiple partners, there may be a greater chance of spreading monkeypox, the CDC says.
The typical gay bar where people go to hang out is different.
“Socialization is part of what [LGBTQ people] do. So I don’t think it’s something we’re stopping. It’s just important to be aware of how monkeypox is transmitted and to be aware of your own risk and how to mitigate that risk,” Daskalakis said.
How to protect yourself
Researchers are also looking into whether the virus can be spread from someone who has no symptoms or through semen, vaginal fluids and fecal matter, according to the CDC. The CDC says wearing a condom can help, but by itself it probably won’t protect against the spread of monkeypox. However, the agency still emphasizes that condoms can prevent other sexually transmitted infections.
There is a vaccine to protect against monkeypox, but demand far outstrips supply.
One thing people can do to protect themselves until the supply improves is to avoid contact with those who are clearly infected, especially close face-to-face contact such as kissing.
“In line with our harm reduction guidelines, thinking about reducing your number of partners, potentially trying to avoid anonymous contacts, is ultimately smart from a risk reduction perspective,” Daskalakis said.
The CDC says people may want to reduce skin contact as much as possible by having sex with clothes on or after covering areas where the rash is present.
If you decide to have sex with someone who has or may have been exposed to monkeypox, talk about the virus ahead of time.
Officials also say to keep in mind that their advice may change as scientists learn more. It can change if monkeypox starts spreading through other contact, such as when people live close together in places like homeless shelters or when people play full-contact sports.
“I think the most important thing is that it’s good to have awareness and some level of concern about some of these things, but it’s not paralysis,” Daskalakis said. “Realistically, skin-to-skin contact of any kind can theoretically transmit monkeypox, but what we’re seeing is that you have to work on it a little bit.”
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