If it is greater than one, the outbreak is growing. Less than one, and it shrinks. “Sex keeps the R above one during this epidemic,” he said. “You’ll get some spillover exceptions, but those won’t keep R above one and that’s why we’re still seeing – and can continue to see – the overwhelming dominance of [monkeypox] among men they have sex with male populations’. If monkeypox had not been spread through sex in this community, the outbreak would likely have died out by now. That’s why Dr Tedros Adhanom Ghebreyesus, head of the WHO, on Wednesday urged men who have sex with men to “reduce the number of sexual partners you have”, while Professor Francois Balloux, director of University College London Genetics Institute, said: “It is not a pathogen that has the potential to become an STD in the heterosexual population.” Still, pundits are digging their heels into the STI label. Why; Technical data, history and stigma. “Smallpox is transmitted through sexual contact and other contact, while other diseases are transmitted only through intimate sexual contact,” Professor David Hayman, an infectious disease epidemiologist at the London School of Hygiene and Tropical Medicine, told the Telegraph. “That’s the distinguishing factor.” Other sexually transmitted diseases that are spread through intimate contact — including herpes and syphilis — are not as effective at transmission outside of sex, he added. For example, although syphilis “could” possibly be spread through skin-to-skin contact, the bacteria prefers “mucous membranes,” such as those found on one’s genitals. Meanwhile, although the monkeypox virus has been detected in semen and saliva, it is not yet clear how infectious it is. Experience in central and western Africa, where the disease is endemic and 75 people have died this year, has also made experts cautious about categorizations. Sexual transmission has not been recognized as the main route of transmission – although, according to Professor Heymann, there had always been suspicions that the virus was quietly exploiting sexual networks. “Whether or not something is sexually transmitted depends a bit on the context,” added Professor Cassell. “If you live in a village where people live in tiny little huts and all the children sleep in the same room, then you’re going to get a lot of close range transmission. “So it’s not the disease, it’s the way the disease is transmitted in a certain environment. It’s not just about the pathogen, it’s about the pathogen in an environment. “Generally speaking, in this country, in this resource-rich environment, it will be sexually transmitted, with some excessive leakage,” he said. “I could say that monkeypox is an accidental STD,” said Professor Heymann.
