Monkeypox will become a ‘permanently entrenched’ STI in the US, Cornell expert warns

Monkeypox may become a ‘permanently entrenched’ sexually transmitted infection (STI) in the US because its early symptoms are easy to miss, an expert has warned.

Dr Jay Varma, an epidemiologist at the Weill Cornell Medical School in New York City, said early infection signs are ‘innocuous’ and in hard to see places — like the inside of the anus — raising the likelihood it is missed.

This gives the rash-causing virus a window in which to transmit to others, before more serious signs like flu-like symptoms and rashes across the body appear. 

Varma added that the tropical disease was also being aided by a lack of STI testing in the US, leaving many cases un-diagnosed.

America has recorded 244 monkeypox cases to date, with another 43 spotted this weekend across 25 states and Washington D.C.

But experts fear this could be just the ‘tip of the iceberg’, with many more infections in the community going undetected.

This weekend the World Health Organization said it would not declare an international emergency over the emergence of the tropical disease.

The above map shows where cases of monkeypox have been detected in America. On the right, the third column of the table shows the number of cases recorded over the last two days

Writing in the New York Times, Varma said: ‘Other experts and I fear that monkeypox will exploit this vulnerability [of a lack of testing] and become a permanently entrenched STI in the United States.

Dr Jay Varma, an epidemiologist from Weill Cornell Medical School in New York City

‘Initial skin changes in this outbreak often appear innocuous and can occur in locations that are easy to miss, such as inside the anus. 

‘Nevertheless, these lesions are highly contagious and can even contaminate surfaces or materials such as towels, which can spread infection to other people. 

‘The skin changes can also mimic those of other infections, such as herpes, molluscum or syphilis, so monkeypox can be easily misdiagnosed by someone not expert in evaluating STIs.’

The rash-causing virus was mostly being passed on through skin-to-skin contact during sex, many officials believe.

He added: ‘While there is some debate among epidemiologists about whether to call monkeypox ‘sexually transmitted’ versus ‘sexually transmissible,’ it is reasonable to consider that sex is one activity that transmits infection, similar to other infections that are transmitted by skin-to-skin contact during sex, like herpes, syphilis and the human papillomavirus.’

Varma compares the situation to that of HIV — which entered America in the 1970s and 80s — and syphilis — which is thought to have arrived with the first settlers in the 1500s.

Cases of common STIs — including chlamydia and gonorrhea — are already thought to be at an all-time high nationwide.

Experts say this is in part because of interruptions to testing during the COVID-19 pandemic, leading to too few people are getting swabbed.

It is likely that many cases of monkeypox are also going undiagnosed due to a lack of testing, or being written off as another infection.

Last weekend America recorded its biggest two-day rise in monkeypox infections since the outbreak was detected last month.

The rash-causing virus is likely spreading under the radar as well. 

Several cases now not linked to a previously known infection or international travel, and experts have warned that poor surveillance methods are leaving populations vulnerable. 

Nationwide, California has the biggest outbreak, with 67 cases, followed by New York with 37 and Florida and Illinois with 27 each.

Globally cases now top more than 4,000 across about 60 countries, but only one death has been recorded to date in an individual from Nigeria.

Cases are mostly being detected among men who have sex with men at present.

But there are fears it will spill over into other groups that are more at risk from the disease, such as the immunocompromised.

The disease is primarily passed on through skin-to-skin contact with infectious lesions.  

Officials are urging gay and bisexual men to be aware of new lesions, rashes or scabs and get in contact with a sexual health clinic

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It comes after the WHO did not declare a global health emergency over the monkeypox outbreak this weekend.

In a statement Saturday, its emergency committee said many aspects of the outbreak were ‘unusual’ and acknowledged that monkeypox — which is endemic in some African countries — has been neglected for years.

‘While a few members expressed differing views, the committee resolved by consensus to advise the WHO director-general that at this stage the outbreak should be determined to not constitute’ a global health emergency, WHO said in a statement.

WHO nevertheless pointed to the ’emergency nature’ of the outbreak and said controlling its spread requires an ‘intense’ response.

The committee said the outbreak should be ‘closely monitored and reviewed after a few weeks’. 

But it would recommend a re-assessment before then if certain new developments emerge — such as cases among sex workers; spread to other countries or within countries that have already had cases; increased severity of cases; or an increasing rate of spread.

Monkeypox is mutating at 12 times the expected rate potentially making it more infectious than previous versions of the virus, experts warn

By Mansur Shaheen, U.S. Deputy Health Editor for DailyMail.com

The monkeypox virus strain that has emerged across the world in recent weeks may be evolving at an abnormally fast rate – making it more infectious than previous versions of the virus.

Researchers at the National Institutes of Health (NIH) found that the virus has replicated up to 12 times its expected pace since 2018.

This means that the virus, which is generally believed to spread by physical touch, contaminated surfaces or very close bodily contact could be able to spread in ways atypical to the tropical viruses normal patterns.

It would explain the recent global monkeypox update, where 201 cases have been detected across 25 U.S. states and Washington D.C., with over 3,500 cases detected worldwide in countries where the virus is not endemic.

The version of monkeypox spreading around the world is of the West African variety, but it is mutating at a pace that would not be expected of a DNA virus (file photo)

Researchers, whose findings are pending official publishing in nature, collected and studied 15 samples of the monkeypox virus for the study.

The NIH team restructured the viruses genetic information to find the number of changes the virus had undergone since this strain began its circulation.

While the virus was detected recently in human populations, experts believe this strain of West African monkeypox first began its movement through the world in 2018.

How viruses mutate and circulate is a generally known science. DNA viruses like monkeypox generally do not rapidly mutate – like COVID-19 does.

The nature of the virus allows it to fix errors that emerge when it replicates, leaving much lower room for mutations to form – and in effect limiting the number of variants.

When researchers did investigate this strain of the virus, they found that it had mutated between six to 12 times the generally believed rate for the virus.

Why exactly this is can not be determined, though the experts believe that this could be playing a role in how the virus has managed to storm the world this year.

Cases of monkeypox have appeared in nearly 50 countries where it is not endemic in recent weeks. 

While occasionally non-endemic nations will find cases – two were detected in the U.S. in 2021 – infections are usually easy to find and outbreaks can be controlled by health officials once they catch wind of circulation.

This outbreak has been different, though, with cases quickly being detected in droves around the world. This could signal a more infectious version of the virus is afoot. 

The 201 cases in the U.S. this year are believed to be a severe undercount as some experts have warned that the country does not have the necessary testing and tracking capabilities to stay on top of each new case.

Some even fear that the virus will become endemic in the U.S., UK and other countries around the world.

Most infections that have been spotted as part of the current outbreak are among gay and bisexual men, both in the U.S. and across Europe.

California, America’s most populous state, has recorded 51 infections thus far – the most of any state. New York and Illinois have also logged 35 and 26 respectively.

With the way the virus has spread through sexual networks, some fear that Pride festivities across America last weekend could lead to a surge in cases.

In preparation, New York City health officials began to rollout monkeypox vaccines to the city’s population last week.

Supply of the shots quickly ran thin, though, with walk-in appointments being cut off on Friday due to high demand.

With the jab taking around four days to fully activate as well, there are questions over whether the shots came out too late to matter ahead of the city’s Pride parade which hosted around two million people.