2. Transmission and risky practices
The virus is transmitted by close and direct contact with an infected person via skin sores (vesicles, patches, wounds), body fluids (saliva, blood) or the mucous membranes of natural orifices.
To a lesser extent, transmission can take place :
- by indirect contact with contaminated objects, cloths, sheets
- and/or prolonged contact through respiratory secretions (spittles and micro droplets, for example by talking for a long time and in close proximity to a sick person).
The virus is present in the body's biological fluids such as saliva, blood and also in lesions. It can enter another person's body through small wounds in the skin (even if they are not visible), and mucous membranes (mouth, nose, eyes, anus, vagina, etc.). Research is underway to find out if monkeypox virus is also present in other body fluids such as breast milk, vaginal secretions or semen.
The more one has close contacts with different people, the greater the risk of being infected with the virus. Monkeypox is not considered a sexually transmitted disease. However, the act of sexual intercourse facilitates the transmission of the virus. For example, the majority of infected people have had a high level of sexual activity with a large number of new and/or anonymous partners.
Period of contagiousness
A person is contagious from the time of flu-like symptoms and before the appearance of skin sores (which usually appear 1 to 3 days after flu symptoms). He/she remains contagious until these sores disappear (see diagram below in French). In the current outbreak, one finds also 'asymptomatic' transmission: that is, a person who is ill may not show any symptoms and still be contagious.
As a precautionary measure, the UK health authorities recommend condom use for at least 8 weeks after infection. The World Health Organisation (WHO) even recommends condom use for 12 weeks after recovery. Scientific studies are underway to clarify this recommendation.
Many cases of monkeypox have been reported in communities of men who have sex with men. What is the situation?
During this outbreak, a majority of monkeypox cases were detected in men who have sex with men (MSM), and in particular in MSM with multiple new and/or anonymous sexual partners.
Stigmatising people because of a disease is never acceptable. Anyone can contract or transmit monkeypox, regardless of their sexuality.
The risk for the population that does not engage in risky practices remains low. Nevertheless, health authorities must remain watchful and vigilant in the face of a new and extraordinary situation, where the number of cases is increasing and contaminations are occurring outside endemic areas and without any link to a return from travel.
People most at risk of being contaminated are those who engage in practices at risk, and therefore have close contact with a contagious person, for example :
- Extensive sexual activity with new and/or different and/or anonymous partners
- Skin-to-skin or skin-to-body fluid contact, or contact with the clothes, sheets or linens of a contagious person
- Health personnel in close contact with an infected person and without appropriate protective equipment
- To a lesser extent, living together (in the same household) with an infected person.