By Winniecynthia Awuor

Even though there is no scientific evidence on whether monkeypox is sexually transmitted, the world health organization (WHO) has advised those at risk to use condoms as a prevention measure against the disease.

This is according to Dr. Rosamund Lewis, the WHO’s lead on monkeypox who observed that there have definitely been reports of detecting this dangerous virus’s DNA in semen.

“Monkeypox can be transmitted through the close contact that is involved in sexual activity and there may be a contribution to infection through contact with semen itself, but we don’t fully know the answers to this question yet,” said Dr. Lewis.

However, she said, the WHO recommends the use of condoms “as a precautionary measure because we don’t know how much of the infection is transmitted through semen, but it is also because it reduces skin-to-skin contact”.

“It’s preferable to avoid skin-to-skin contact altogether if someone has monkeypox, but at the very least, using a condom may reduce that risk while we do more studies to learn more,” she added. “This applies to bisexual and gay men who have sex with men and anyone who has multiple sexual partners.”

Lewis added that there had been no reports yet of monkeypox transmission through blood transfusions.

Elsewhere, Italian researchers reported in the Lancet that they had found monkeypox DNA in the semen of a 39-year-old patient living with HIV who self-identified as a man who has sex with men, and a sex worker. He had reported condomless sex with several male partners in the month before infection.

“Overall, our findings support that prolonged shedding of monkeypox virus DNA can occur in the semen of infected patients for weeks after symptoms onset, and show that semen collected in the acute phase of infection (day six after symptom onset) might contain a replication-competent virus and represent a potential source of infection,” researchers from the National Institute for Infectious Diseases in Italy said.

“Whether the infectious monkeypox virus found in semen could be associated with seminal cells or if viral replication occurs in the genital tract remains to be established,” they note, adding

“The isolation of live replication-competent monkeypox virus from semen, and prolonged viral DNA shedding, even at low viral copies, might hint at a possible genital reservoir.”

On top of that, Nigerian physician Dr. Dimie Ogoina from the Niger Delta University has previously raised the possibility of both sexual transmission of monkeypox and whether it could be transmitted by asymptomatic people.

“Monkeypox manifests in rashes. Would a person still engage in sex with these rashes? We need to look at asymptomatic transmission,” said Ogoina at a WHO meeting in June, called to look at the ongoing outbreak.

While writing about that outbreak in Plos One, Ogoina and colleagues noted that “a substantial number of our cases who were young adults in their reproductive age presenting with genital ulcers, as well as concomitant syphilis and HIV infection”

He later told NPR that a sexual history assessment of patients in the 2017 outbreak found that many had multiple sexual partners and sex with sex workers.

“Although the role of sexual transmission of human monkeypox is not established, sexual transmission is plausible in some of these patients through close skin to skin contact during sexual intercourse or by transmission via genital secretions,” Dr. Ogoina and colleagues noted in the PlosOne article, calling for further studies on the role of genital secretions in the transmission of human monkeypox.

They also noted that HIV infection might negatively influence the morbidity of human monkeypox “as patients with HIV had more severe skin lesions associated with genital ulcers” than HIV-negative individuals.

Dr. Lewis also talked about precautions for reducing monkeypox such as self-care and reducing the number of sexual partners to avoid skin-skin contact which is a widespread means of the virus’s transmission.

“Protecting oneself involves the actions we’ve been talking about from the beginning, which are: reducing physical contact with anyone who has monkeypox, reducing the number of sexual partners, reducing casual sex or new partners, and being more open about one’s risks and having conversations with others that may highlight mutual protection and protection of each other,” Lewis stressed.

“This is not a disease that is limited to a specific group. What is happening is that it is being spread primarily in one risk group. We know that the majority of cases are occurring among bisexual men who are gay or bisexual. However, physical contact of any kind with anyone who has monkeypox would put someone at risk.”