Penis Rectum

I continue to hear this messaging about how monkeypox is transmitted: "prolonged skin to skin contact," "prolonged skin to skin contact as happens during sex."   

While undoubtedly some cases are due to skin to skin contact, the vast majority of cases in NYC are due to:

Penis into rectum.

Penis into mouth.

These words are not taboo. They are the medical names of body parts. How do we know this is the route of transmission? We have been speaking to patients and their medical providers since the beginning of the outbreak. Anyone who hasn't been speaking with patients and providers shouldn't be giving advice. Here's the evidence:

• Overwhelmingly the location of the lesions have been on the shaft of penis, perianal, rectum, and oropharynx (mouth and throat).
• Frequency of painful proctitis. Not previously reported in monkeypox outbreaks.
• Predominance in MSM. It is a sexual network, not simply a social network.
• Viral DNA has been found in saliva and semen. Live virus studies are pending.
• Other viruses, Zika and Ebola, have been transmitted sexually 
• Many patients report that their partners had no symptoms or rash.
• Cases continue to increase, in part because of poor public messaging.

The epidemiology suggests that people may be infectious with no or minimal skin findings. Prevention is the ONLY way to slow the pandemic. Decrease the number of sexual encounters.