NEW YORK (AP) — The spread of monkeypox in the U.S. may represent the dawn of a new sexually transmitted disease, although some health officials say the virus that causes the pimple-like bumps may still be contained before to establish firmly.
Experts disagree about the disease’s likely path, with some fearing it is becoming so widespread that it is on the verge of becoming an established sexually transmitted disease — like gonorrhea, herpes and HIV.
But no one is really sure, and some say tests and vaccines could still stop the epidemic from spreading.
So far, more than 2,400 cases have been reported in the US as part of an international outbreak that emerged two months ago.
Health officials are not sure how quickly the virus has spread. They only have limited information about people who have been diagnosed, and they don’t know how many infected people may be unknowingly spreading it.
They also don’t know how well vaccines and treatments work. One hurdle: Federal health officials don’t have the authority to collect and link data on who has been infected and who has been vaccinated.
With such huge question marks, estimates of how big the outbreak will become in the US this summer vary widely, from 13,000 to perhaps more than 10 times that number.
Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said the government’s response is getting stronger every day and vaccine supplies will soon increase.
“I think we still have an opportunity to get this under control,” Walenski told The Associated Press.
Monkeypox is endemic in parts of Africa where humans have been infected through bites from rodents or small animals. It usually does not spread easily among people.
But more than 15,000 cases have been reported this year in countries that have historically not seen the disease. In the US and Europe, the majority of infections have occurred in men who have sex with men, although health officials have stressed that anyone can catch the virus.
It is mainly spread by skin-to-skin contact, but can also be spread through bedding used by a monkeypox patient. Although it is spreading through the population as a sexually transmitted disease, officials are watching for other types of spread that could expand the outbreak.
Symptoms include high fever, body aches, chills, fatigue, and bumps on body parts. The disease is relatively mild in many men and no one has died in the US, but people can be contagious for weeks and the lesions can be extremely painful.
When monkeypox appeared, there was reason to believe that public health officials could control it.
The telltale strikes were supposed to make infections easy to identify. And because the virus spreads through close personal contact, officials believe they can reliably track its spread by interviewing infected people and asking who they’ve been intimate with.
It didn’t turn out that easy.
Because monkeypox is so rare in the U.S., many infected men — and their doctors — may have attributed their rashes to some other cause.
Contact tracing was often hampered by infected men who said they did not know the names of all the people they had sex with. Some report multiple sexual interactions with strangers.
It didn’t help that local health departments, already burdened with COVID-19 and dozens of other diseases, now had to find resources to do intensive contact tracing work with monkeypox as well.
In fact, some local health officials have given up expecting much from contact tracing.
There was another reason to be optimistic: the US government already had a vaccine. The two-dose regimen, called Jynneos, was licensed in the US in 2019 and recommended last year as a monkeypox treatment.
When the outbreak was first identified in May, US officials had only about 2,000 doses available. The government released them, but limited the photos to people found through public health investigations to have been recently exposed to the virus.
Late last month, as more doses became available, the CDC began recommending that vaccines be offered to those who realize on their own that they may have been infected.
Demand has outstripped supply, with clinics in some cities quickly running out of vaccine doses and health officials across the country saying they don’t have enough.
That’s changing, Walenski said. As of this week, the government has distributed more than 191,000 doses and has another 160,000 ready to be shipped. At least 780,000 doses will be available as early as next week.
Once current demand is met, the government will consider expanding vaccination efforts.
The CDC estimates that 1.5 million men in the U.S. are considered at high risk for the infection.
Testing has also expanded. More than 70,000 people could be tested each week, far more than the current demand, Walenski said. The government has also launched a campaign to educate doctors and gay and bisexual men about the disease, she added.
Donal Bizanzio, a researcher at RTI International, believes that US health officials will be able to contain the epidemic before it becomes endemic.
But he also said this won’t be the end. New outbreaks of cases are likely to occur when Americans become infected from people in other countries where monkeypox continues to circulate.
Walensky agrees that such a scenario is likely. “If it’s not contained around the world, we’re always at risk of flare-ups” from travelers, she said.
Shawn Kiernan of the Fairfax County Health Department in Virginia said there is reason to be cautiously optimistic because so far the outbreak is concentrated in one group of people — men who have sex with men.
The spread of the virus among heterosexual people would be a “tipping point” that could occur before it is widely recognized, said Kiernan, chief of the department’s infectious disease division.
Spread to heterosexuals is only a matter of time, said Dr. Edward Hook III, professor emeritus of infectious diseases at the University of Alabama at Birmingham.
If monkeypox becomes an endemic sexually transmitted disease, it will be another challenge for health departments and doctors who are already struggling to keep up with existing STDs.
Such work has long been underfunded and understaffed, and much of it has simply been put on hold during the pandemic. Kiernan said HIV and syphilis were priorities, but work on common infections such as chlamydia and gonorrhea came down to “counting cases and that’s it.”
Cases of gonorrhea, chlamydia and syphilis have been on the rise for years.
“In general,” Hook said, doctors “do a lousy job of taking sexual histories, questioning, and acknowledging that their patients are sexual beings.”
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Associated Press writer Janie Harr in San Francisco contributed to this report.
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The Associated Press Health and Science Division is supported by the Howard Hughes Medical Institute Science Education Division. AP is solely responsible for all content.
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