by Tyler Goodlet and Spencer Jenkins
Editor’s note: This Story will be updated as new facts, anecdotes and more arise.
When John Doe (name kept anonymous) noticed his swollen lymph nodes, fever and headache, he suspected that he contracted a sexually transmitted infection (STI). He decided to head to the Speciality Clinic in Jefferson County for an STI screening. Specialty Clinic is available to anyone seeking confidential counseling, testing, and treatment of STIs. The clinic operates on appointments only. Call (502) 574.6699 to make an appointment.
“Once my rapid syphilis test came back negative the nurse practitioner and I both knew it had to be monkeypox.” Doe said. “I was just kind of shocked because I just wasn’t sure how I got it.”
With only a small amount of monkeypox cases in Kentucky, it’s hard for anyone to know where they contracted it. There are only three cases as of July 11, according to Dr. Jeff Howard, medical director for the local health department. Dr. Stephanie Lokits, the public health department’s assistant director of nursing, said there is “no correlation” between the three cases.
Initially Doe’s symptoms were intense. Bad headaches, chills/fever and drenching night sweats. One of the rashes was on a very sensitive part of his body and in combination with another health condition, it caused a lot of pain that required an Emergency Room visit and prescription pain management.
“After all that, it was just a waiting game at home for the spots to heal COMPLETELY over,” he said.
According to the Center for Disease control, people with monkeypox in the current outbreak generally report having close, sustained physical contact with other people who have monkeypox. While many of those affected in the current global outbreaks are gay, bisexual, or other men who have sex with men, anyone who has been in close contact with someone who has monkeypox can get the illness.
Doe said that prior to contracting monkeypox, it was barely on his radar.
“As far as anyone skeptical about it I would say, it’s in the community now — it’s something we should be vocal and vigilant about because we can’t expect others to advocate for us” he said. “Push for more access to the vaccine and keep up with your sexual health and safe sex practices.”
The U.S. Department of Health and Human Services announced on July 7 that it will make an additional 144,000 doses of the JYNNEOS vaccine available to states and jurisdictions, as part of the Biden Administration’s comprehensive strategy to combat monkeypox and protect Americans most at risk from monkeypox.
In a recent Newsweek article, it is stated that the ten states with the highest numbers of cases are California, New York, Illinois, Florida, Massachusetts, Pennsylvania, Texas, Virginia, Georgia and Maryland.
Kentucky is limited in its access to the vaccine. The health department in Jefferson County has a small amount of vaccine for monkeypox, Howard said, though only certain people can get the limited doses.
“The vaccine is suggested for those who have what we classify as a high level of close contact with an individual and who have significant risk factors for disease,” Lokits said.
According to a Courier Journal article, the department received 20 courses of the vaccine and has 10 left. The vaccine is a two-dose series administered eight weeks apart, with immunity kicking in two weeks after the last dose. Lokits said more can be requested from the state if needed.
One of Doe’s biggest takeaways from this is experience is to exercise the caution we should always be exercising.
“Asking questions about your partners sexual health should always happen,” he said. “But ultimately things like these come with the fun and it’s important to be quick to act and stay honest with your healthcare provider about what’s going on with your body.”
SO WHAT’S GOING ON?
One word, monkeypox. What is it? Who’s getting it? How bad is it? What tools do we have to fight it? These are the questions that I have been asking myself since the outbreak was detected in earlier this year and it’s the questions friends and family members have asked. Let’s dive in and attempt to answer them.
What is it?
Monkeypox is a poxvirus and a cousin of the infamously eradicated disease smallpox. The name is a bit of a misnomer as it was discovered in a lab in 1958 during two outbreaks in monkeys being kept for research. It wasn’t until 1970 that the first human case was identified in the Democratic Republic of Congo. Since then, most cases have occurred in central and western Africa with sporadic outbreaks outside of the region. Historically these outbreaks have been linked to contact with infected animals that are indigenous to these parts of Africa. Additionally, there are two monkeypox “clades” (groups that share a common ancestor) circulating in the current outbreak: the Congo Basin clade and the west African clade. The WHO states that the Congo Basin clade has more severe disease and was thought to be more transmissible. Both of these clades spread via the following:
- Close physical contact with someone with a monkeypox rash
- Body fluids
- Respiratory droplets
- Contact with contaminated materials such as bedding or clothing
Who’s been affected?
While this disease can infect anyone, it seems that most recent outbreak has been mostly, but not completely, occurring in gay, bi, trans men, trans women, and cisgender men who have sex with men (MSM). This is especially concerning given the fact that we know LGBTQIA+ people are more likely to be uninsured, less likely to have access to a regular healthcare provider, and are likely to report poor quality of care when they do seek treatment. With this lack of access there’s a higher chance that someone won’t be able or know where to go if they believe they are experiencing symptoms. We need community members to be open and honest on the situation and do everything that we possibly can to link people to care.
How bad is it?
Monkeypox is usually a self-limiting disease meaning that folx usually fully recover from the infection without treatment. Unfortunately, there have been 3 deaths worldwide due to monkeypox illness this year. There have been no deaths reported in the US. According to the KY Department for Public Health and CDC, after exposure symptoms start 5-21 days and include:
- A rash or sores may be located on or near the genitals or anus but could also be on other areas like the hands, feet, chest, or face.
- The sores will go through several stages, including scabs, before healing.
- The sores can look like pimples or blisters and may be painful or itchy.
- Sores may be inside the body, including the mouth, vagina, or anus.
- Muscle aches
- Swollen lymph nodes
You are still considered infectious until all the lesions have completely healed, including scabs and have new skin growth over them. This healing period can take several weeks.
What tools do we have to fight it?
The COVID-19 pandemic has taught us a lot about what works and what doesn’t in terms of infection control. Monkeypox isn’t new and we’ve studied it for years now. However, the current state of testing is reminiscent to COVID-19 testing at the beginning of the pandemic; we simply aren’t testing enough individuals. Some of the cases in the US did not have known contact with individuals who have tested positive for monkeypox. This means that undetected community spread is likely occurring, and more targeted testing needs to happen quickly.
As of July 11, Kentucky has identified 3 cases, 790 in the US, and over 8000 worldwide. Because monkeypox specific tests can only be done at the CDC and can be time consuming, public health entities have had to use tests for Orthopox viruses to quickly identify cases and provide post-exposure prophylaxis (PEP) to folx who have been in contact with a probable case. On a positive note, the Biden-Harris administration is working with commercial labs to make testing more accessible to healthcare providers. As of 07/06/22 Labcorp has begun commercial testing. This means that if you seek out a healthcare provider and they suspect monkeypox infection you can get the test done there and get your results in 2-3 days after they receive the specimen. If you think that you should be tested, call your healthcare provider or your local health department.
Isolation and Quarantine
These words are triggering for some, but they are effective tools in outbreak control. Unfortunately, if you test positive for monkeypox the isolation time is likely to be much longer than what we were used to for COVID-19 infection. This is because the infectious period lasts from the time you develop lesions to when those lesions completely heal. If we want to control this outbreak, we are going to need resources to help support those individuals in isolation. Those with in-person work requirements are going to be the most affected by this. Social support connectors were key in getting individuals who were infected with COVID-19 the resources that they needed such as thermometers, cleaning supplies, grocery and prescription deliveries, etc.
Vaccines and Antivirals
There are currently two vaccines that are approved for use in preventing monkeypox infection: ACAM2000 and JYNNEOS. The US has a limited number of doses in the Strategic National Stockpile (SNS) that are currently being deployed out to each state. As of June 28th, the US has sent over 9000 doses to 32 states and jurisdictions. In the coming weeks and months more doses will be allocated to states and jurisdictions to begin vaccinating those at higher risk. This will likely look like the tiered rollout of the COVID-19 vaccine. We know that vaccine inequity was an issue with the COVID-19 vaccine rollout so we should also expect the same issues in this rollout. NYC has already demonstrated the need to make vaccination more accessible to lower socio-economic populations and those who don’t have internet access. One antiviral medication can be used for lessening the symptoms of monkeypox, TPOXX (tecovirimat). This treatment is typically only considered for those who are with severe disease or high risk for severe disease and quantities are extremely limited.
There’s been some internet banter regarding CDC’s recent guidance on “Social Gatherings & Safer Sex” but these are recommendations for REDUCING the risk of infection at social gatherings (such as raves or circuit parties) and during sex. If you’re experiencing symptoms, then you should contact your healthcare provider or the health department for further guidance and potential testing.
LGBTQIA+ community leaders and organizations should be working closely with public health officials to ensure that equitable access to vaccines, tests, and treatment. We need to raise awareness of how this disease spreads and how we can prevent it. We are no strangers to advocating for ourselves and making our voices heard; this should be no different. Be sure to stay up to date on guidance from your local health department (links to individual health departments are on the middle of this page), KY Dept for Public Health, and CDC. Don’t be afraid to talk openly with your friends, family, and sexual partners about your concerns or symptoms. An open and honest dialogue about the disease and how to reduce risk is key in controlling the outbreak and protecting our LGBTQIA+ siblings out in the community.