An outbreak of a disease called monkeypox is currently taking place in many countries that do not typically have cases. This can be concerning, especially for people whose loved ones or community have been affected. Some cases have been identified through sexual health clinics in communities of gay, bisexual and other men who have sex with men.
It is important to note that the risk of monkeypox is not limited to men who have sex with men. Anyone who has close contact with someone who is infectious is at risk. However, given that the virus is being identified in these communities, learning about monkeypox will help ensure that as few people as possible are affected and that the outbreak can be stopped.
This public health advice contains information on how monkeypox spreads, what to do if you think you have symptoms and how to protect yourself and others. It can be used by community leaders, influencers, health workers and people attending social events and parties to inform and engage communities of men who have sex with men.
What you need to know
An outbreak of a disease called monkeypox is happening in some countries where the virus is not typically found. Some of these cases are being found in communities of gay, bisexual and other men who have sex with men. Transgender people and gender-diverse people may also be more vulnerable in the context of the current outbreak.
Rash with blisters on face, hands, feet, eyes, mouth and/or genitals
Swollen lymph nodes
You can catch monkeypox if you have close physical contact with someone who is showing symptoms. This includes touching and being face-to-face.
Monkeypox can spread during close skin-to-skin contact during sex, including kissing, touching, oral and penetrative sex with someone who has symptoms. Avoid having close contact with anyone who has symptoms.
Protect yourself and others by:
Isolating at home and talking to a health worker if you have symptoms
Avoid skin-to-skin or face-to-face contact, including sexual contact with anyone who has symptoms
Clean hands, objects, and surfaces that have been touched regularly
Wear a mask if you are in close contact with someone with symptoms
The article is published courtesy of the World Health Organization (WHO).
Scientific strides in HIV treatment and prevention have reduced transmissions and HIV-related deaths significantly in the United States in the past two decades. However, despite coordinated national efforts to implement HIV services, the epidemic persists, especially in the South.
It also disproportionately impacts marginalized groups, such as Black/African-American and Latinx communities, women, people who use drugs, men who have sex with men, and other sexual and gender minorities. Following the release of the HIV National Strategic Plan and marking two years since the launch of the Ending the HIV Epidemic: A Plan for America (EHE)—a U.S. Department of Health and Human Services initiative to reduce new HIV transmissions by at least 90% by 2030—researchers, advocates, and other stakeholders reported on the HIV epidemic response in The Lancet HIV in the USA Series, published online today.
Literature reviews, commentaries, and data analyses in the series outline recommendations to overcome barriers to implementing HIV services, such as counseling, testing, treatment, pre-exposure prophylaxis (PrEP), and syringe services programs. These services are critical to preventing new HIV transmissions and helping people living with HIV achieve and maintain a “durably undetectable” viral load (the amount of HIV in the blood). Maintaining an undetectable viral load both preserves individual health and eliminates the risk of sexually transmitting the virus to others, a concept known as Undetectable = Untransmittable (U=U).
By leveraging these services and addressing structural barriers, the experts argued, the EHE goals remain attainable and important, even as the COVID-19 pandemic presents new challenges and exacerbates existing health disparities.
The series was funded in part by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health within HHS. The authors received additional support from the NIH-funded Centers for AIDS Research and NIH’s National Institute of Allergy and Infectious Diseases (NIAID).
“Scientific advances have transformed the course of HIV in individuals. To transform the course of the epidemic, we need to expand care and prevention strategically to those who need it most,” said NIDA Director Nora D. Volkow, M.D. “That means taking a hard look at who has been excluded from services and take immediate steps to overcome systemic barriers like stigma, structural racism, and other forms of discrimination to connect hardly reached people—such as individuals with substance use disorders—with HIV testing, prevention, and treatment.”
The series’ authors recommend allocating resources to the areas and populations most hard-hit by the HIV epidemic, especially the U.S. South, where 52% of new HIV transmissions occurred in 2018 despite being home to only 37% of the U.S. population. The recommendation echoes a key EHE strategy to prioritize the 57 counties, U.S. territories, and states in which more than half of U.S. HIV transmissions occurred in 2016 and 2017 for targeted interventions.
“To end the HIV epidemic, we must continue to develop and deploy novel HIV treatment and prevention strategies suited to the different needs and preferences of diverse populations disproportionately affected by HIV,” says NIAID Director Anthony S. Fauci, M.D. “It is also essential that HIV health services continue during the COVID-19 pandemic.”
The authors explained that stark disparities in HIV outcomes also exist between certain age, racial, and ethnic groups, as well as between sexual and gender identities. While HIV diagnoses decreased overall and among white men who have sex with men between 2009 and 2018, new cases remained stable among Black/African-American men who have sex with men and increased among young people aged 25-34 and Latino men who have sex with men. While Blacks/African Americans make up only about 13% of the U.S. population, they accounted for 43% of HIV-related deaths in 2018. Researchers suggested that culturally appropriate, tailored interventions may help communities respond to the unique needs of people in—or at the intersections of—these groups.
Such interventions to promote HIV prevention and treatment adherence, the authors suggested, should take a multi-faceted approach and address the whole individual.
“We have incredible tools to prevent and treat HIV, but people may not fully utilize them if they are facing personal or structural issues that pose more immediate hardship like substance use and mental health disorders,” said Chris Beyrer, M.D., M.P.H., investigator at the Johns Hopkins Bloomberg School of Public Health, Baltimore, and a lead author on the series. “You may struggle to take a daily medication if you are facing food insecurity or cannot find affordable treatment for your substance use disorder.”
The authors detailed additional economic barriers to accessing HIV health services in the United States. These included unequal access to Medicaid, on which 40% of people living with HIV rely, depending on one’s state of residence. The series’ authors recommended implementing universal healthcare coverage and expanding safety net programs for the uninsured or underinsured, such as the Ryan White HIV/AIDS Program, on which 82% of uninsured people living with HIV rely for medical care.
Stigma, discrimination, and bias by healthcare providers were among major barriers to care identified by the series authors and disproportionately affected marginalized racial groups, people who use drugs, and sexual and gender minorities. Healthcare professionals may help address these concerns by cultivating informed, supportive care practices that integrate mental health care and substance counselling. Because internalized HIV stigma can also negatively affect a person’s mental health and adherence to medication, the authors recommended promoting awareness of U=U through a national campaign.
While the series’ authors cite a large body of HIV research in making these recommendations, they also highlighted opportunities for additional research that could help end the HIV epidemic. Women make up one out of every four people living with HIV in the United States, and rates of HIV transmission are high among transgender people, demonstrating the need for continued efforts to ensure the needs of these populations are taken into account at all stages of clinical research. The authors also supported continued investment in efforts to develop a preventive HIV vaccine and HIV cure, both of which would accelerate an end to the HIV epidemic in the U.S. and around the globe.
Doctors need to expand communication on risks and the importance of vaccination, Rutgers researchers say.
By Michelle Edelstein
Young sexual minority men — including those who are gay, bisexual, queer or straight-identified men who have sex with men — do not fully understand their risk for human papillomavirus (HPV) due to a lack of information from health care providers, according to Rutgers researchers.
A Rutgers study published in the Journal of Community Health, examined what young sexual minority men — a high-risk and high-need population — know about HPV and the HPV vaccine and how health care providers communicate information about the virus and vaccine.
About 79 million Americans are infected with HPV, with about 14 million becoming newly infected each year, according to the Centers for Disease Control and Prevention. As a sexually transmitted infection, HPV can lead to several types of cancer, including anal and penile cancer, and is particularly concerning for sexual minority men due to the high prevalence of HIV and smoking in this community and the low HPV vaccination rates overall among men.
“Particularly in light of the decades-long focus on gay men’s health care as HIV care, there is a missed opportunity for HPV prevention in the community,” said study co-author Caleb LoSchiavo, a doctoral student at the Rutgers School of Public Health.
The researchers, who are members of the Rutgers School of Public Heath’s Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), analyzed interviews with sexual minority men in their early 20s in New York City and determined they knew little about HPV infection — including transmission, signs, symptoms and cancer risk — and vaccination.
They also found that the men did not prioritize HPV vaccination due to the incorrect perception that HPV is an issue that exclusively or primarily affected women.
“Everyone who is sexually active — regardless of gender, sexual orientation, partners’ genders, relationship or marital status — should talk to their doctor about receiving the HPV vaccine to prevent a future generation who may develop HPV-related cancers, such as cervical, oral and anal cancer, as we have seen emerging in Baby Boomers and Gen-Xer s,” said Perry N. Halkitis, Rutgers School of Public Health dean, CHIBPS director, and PI of the study.
The U.S. Food and Drug Administration has expanded the use of HPV vaccine to people between the ages of 27 to 45. Originally, it was prescribed for those between the ages of 9 to 26.
In the study, researchers found that health care providers rarely discuss HPV and the HPV vaccine with patients who are young sexual minority men, and when they do, their communication is often inadequate in conveying potential risks of HPV and benefits of vaccination.
“Clinicians have a direct role in expanding the availability of LGBTQ-competent healthcare,” said lead author Jessica Jaiswal, an assistant professor at the University of Alabama, and CHIBPS affiliate. “By learning about sexual minority men’s diverse health needs and routinely offering the HPV vaccine, we can move toward a health promotion model and not only a disease prevention model.”
The study was funded by the National Institute of Allergy and Infectious Diseases and the National Institute on Drug Abuse.
A research team led by Univ.-Prof. Dr. Florian Klein of the Institute of Virology of the University Hospital Cologne and the German Center for Infection Research (DZIF) has identified a new highly active antibody targeting HIV.
Whereas the development of viral resistance limits the efficacy of previously described HIV antibodies, the newly identified antibody 1-18 can continuously suppress viral replication.
1-18 therefore has high potential for successful application in the prevention and treatment of HIV infection. An article describing antibody 1-18 has now been published in Cell.
Antiretroviral drugs are the gold standard for the treatment of HIV infection. They are highly effective in suppressing replication of the virus but require lifelong daily application and can be associated with side effects. Due to the high mutability of HIV and its capacity for rapid adaptation, combinations of antiretroviral agents are required to prevent the development of drug resistance and treatment failure.
Broadly neutralizing antibodies are a focus of ongoing research on novel options for the treatment and prevention of HIV infection. Their mode of action substantially differs from regular antiretroviral drugs, as antibodies target the virus through specific binding of HIV surface proteins.
Clinical trials have demonstrated the potential of broadly neutralizing antibodies by reducing the viral load in the blood of HIV-infected individuals. Similar to antiretroviral drugs, however, the effects of single antibodies were only temporary because of the development of viral resistance.
Scientists at the University Hospital Cologne have now identified a novel antibody called 1-18 that targets HIV. This antibody is highly potent and showed activity against 97% of the tested HIV variants. „1-18 is therefore among the best HIV neutralizing antibodies described to date“, says Dr. Philipp Schommers, resident physician at the Department I of Internal Medicine and one of the first authors of the article.
In collaboration with colleagues at the California Institute of Technology (Pasadena, USA), the researchers identified the mode of action of antibody 1-18 in detail. 1-18 binds and inactivates a surface structure of HIV that is particularly relevant because it is essential for viral infection and replication.
The therapeutic efficacy of the newly identified antibody 1-18 was studied using a mouse model that allows recapitulation of HIV infection as it occurs in humans. In this model, other broadly neutralizing antibodies showed only short-term effects because of the rapid development of viral resistance. In contrast, treatment with the antibody 1-18 resulted in suppression of the viral load that was maintained for the duration of therapy. „These results indicate that development of viral resistance against the new antibody 1-18 is restricted when compared to other antibodies“, says Dr. Henning Grüll, resident physician at the Institute of Virology and also first author of the work.
Due to its high potency, the scientists consider 1-18 a promising candidate for HIV immunotherapy. “In addition, 1-18 has great potential for preventing HIV infection by passive immunization“, adds Prof. Dr. Florian Klein, lead and senior author of the study. Clinical trials are now planned to further investigate antibody 1-18.
Infections that can affect the health of the pregnant woman, the pregnancy, and the baby after delivery include (but are not limited to):
Bacterial vaginosis (pronounced vaj-in-NOH-sis) is the most common vaginal infection in women of reproductive age. It increases the risk of contracting sexually transmitted infections (STIs) and may play a role in preterm labor. The condition results from a change in the balance of bacteria that normally live in the vagina. Having unprotected sex and douching can increase the risk of bacterial vaginosis. The Centers for Disease Control and Prevention (CDC) recommends that pregnant women get tested for bacterial vaginosis if they have symptoms and get treated if necessary.
Chlamydia infection during pregnancy is associated with an increased risk of preterm birth and its complications. If the infection is present and untreated at the time of delivery, it can lead to eye infections or pneumonia in the infant. In most hospitals, infants’ eyes are routinely treated with an antibiotic ointment shortly after birth. The ointment can prevent blindness from exposure to chlamydia bacteria during delivery in case the pregnant woman had an undetected infection.
Cytomegalovirus (CMV) (pronounced sahy-toh-meg-uh-loh-VAHY-ruhs) is a common virus present in many body fluids that can be spread through close personal contact, such as kissing or sharing eating utensils, as well as sexual contact. The virus usually does not cause health problems, but once it is in a person’s body, it stays there for life and can reactivate at different times. A pregnant woman may not even know she has the infection, and she may pass the virus on to her fetus, causing congenital CMV infection. Most infants with congenital CMV infection never show signs or have health problems. However, some infants have health problems such as hearing or vision loss, seizures, or intellectual disabilities that are apparent at birth or that develop later during infancy or childhood. Currently, routine screening for CMV during pregnancy is not recommended. Researchers are working on treatments for CMV and vaccines to try to prevent new infections during pregnancy and to reduce the risk of transmission to the infant. Congenital CMV infection can be diagnosed by testing a newborn baby’s saliva, urine, or blood. Treatment with antiviral drugs may decrease the risk of health problems and hearing loss in some infected infants.
Fifth disease is caused by human parvovirus (pronounced PAHR-voh-vahy-ruhs) type B19. The virus causes a common childhood disease that spreads easily from person to person. Children who get it usually have a fever and a red rash on their cheeks. Parvovirus B19 usually does not cause problems for pregnant women or the fetus, but in rare cases, the woman might have a miscarriage or the fetus could develop anemia. There is no vaccine or treatment for fifth disease. You can reduce your chance of being infected with parvovirus B19 or infecting others by avoiding contact with people who have parvovirus B19 and by thoroughly and regularly washing your hands. Sometimes health care providers recommend testing pregnant women to see if they are immune to the virus already.
Untreated gonorrhea infection in pregnancy has been linked to miscarriage, preterm birth and low birth weight, premature rupture of the membranes surrounding the fetus in the uterus, and infection of the fluid that surrounds the fetus during pregnancy. Gonorrhea can also infect an infant during delivery as it passes through the birth canal. If untreated, infants can develop eye infections and blindness. In most hospitals, infants’ eyes are routinely treated with an antibiotic ointment shortly after birth to prevent eye problems from exposure to gonorrhea during delivery, in case the pregnant woman had an undetected infection. Treating gonorrhea as soon as it is detected in pregnant women reduces the risk of transmission.
Group B streptococcus (GBS) can cause serious health problems in infants. But giving antibiotics during labor can prevent the spread of GBS, so it’s important to get tested for the infection during pregnancy. Learn more about GBS and pregnancy.
Pregnant women who get infected with genital herpes late in pregnancy have a high risk of infecting their fetus. The risk of infection is particularly high during delivery. Herpes infections in newborns are serious and potentially life-threatening. Infection with the herpes virus during pregnancy or at the time of delivery can lead to brain damage, blindness, and damage to other organs. Rarely, herpes infection during pregnancy can lead to serious complications in the mother, including severe liver damage and possibly death.
If a pregnant woman has had genital herpes in the past, there are medications that she can take to reduce the chance that she will have an outbreak, which also reduces the risk to her fetus.If a woman has active herpes sores when she goes into labor, the infant can be delivered by cesarean section to reduce the chance that the infant will come in contact with the virus.
If a woman is infected with hepatitis B virus (HBV) during pregnancy, the virus could infect her fetus. The likelihood of transmission depends on when during pregnancy the mother was infected. If the mother gets the infection later in her pregnancy, the risk that the virus will infect her fetus is quite high. If the infection occurs early in pregnancy, the risk of the virus infecting the fetus is much lower. For more information about Hep B during pregnancy, visit the Centers for Disease Control and Prevention (CDC) website. In infants, HBV can be serious and can lead to chronic liver disease or liver cancer later in life. In addition, infected newborns have a very high risk of becoming carriers of HBV and can spread the infection to others.
In some cases, if a woman is exposed to HBV during pregnancy, she may be treated with a special antibody to reduce the likelihood that she will get the infection.All healthy infants should be vaccinated against HBV to give them lifelong protection.Infants born to women with evidence of ongoing HBV infection (HBV surface antigen positive) should also receive hepatitis B hyperimmune globulin as soon as possible after birth. Hepatitis C virus (HCV). CDC offers more information about HCV.
HIV/AIDS. HIV can be passed from mother to infant during pregnancy before birth, at the time of delivery, or after birth during breastfeeding.
Listeria or listeriosis (pronounced li-steer-ee-OH-sis) is a serious infection usually caused by eating food contaminated with a particular type of bacteria. Infection during pregnancy can lead to pregnancy loss, stillbirth, preterm birth, or life-threatening infection of the newborn. Listeriosis is most often associated with eating soft cheeses and raw milk, but recent outbreaks have been associated with fresh and frozen produce. Prevention recommendations include checking food labels to avoid eating unpasteurized cheese (made from raw milk) and other actions. Learn more about preventing listeria during pregnancy.
Getting rubella (sometimes called German measles) during pregnancy can cause problems with the pregnancy as well as birth defects in the infant. Health care providers recommend that women get vaccinated against rubella before they get pregnant. Learn more about rubella and pregnancy.
Syphilis may pass from an infected mother to her fetus during pregnancy. The infection has been linked to preterm birth, stillbirth, and, in some cases, death shortly after birth. Untreated infants who survive tend to develop problems in many organs, including the brain, eyes, ears, heart, skin, teeth, and bones. All pregnant women should be screened for syphilis during their first prenatal visit. Women considered to be high risk should be screened again in the third trimester.1
Toxoplasmosis (pronounced tok-soh-plaz-MOH-sis) is a disease caused by a parasite that can be present in cat feces or used cat litter. Cats get the parasite from eating small animals or birds. In humans, the disease is usually mild, but if the parasite passes from a pregnant woman to the developing fetus, it can cause intellectual disabilities, blindness, or other problems. Women who are trying to become pregnant or are pregnant can take steps to prevent exposure to the parasite, such as having someone else clean or change the cat litter box and wearing rubber gloves to handle cat litter or while gardening.
Zikais caused by a virus spread mainly by the bite of a certain type of mosquito, but it is also spread through sexual contact. Although its symptoms are usually mild, Zika infection during pregnancy can cause pregnancy loss and other pregnancy complications, as well as birth defects and other problems for the infant.
An investigational oral antibiotic called zoliflodacin was well-tolerated and successfully cured most cases of uncomplicated gonorrhea when tested in a Phase 2 multicenter clinical trial, according to findings published today in the New England Journal of Medicine. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, sponsored the clinical study.
This illustration depicts a three-dimensional (3D) computer-generated image of a number of drug-resistant, Neisseria gonorrhoeae diplococcal bacteria. U.S. Centers for Disease Control and Prevention – Medical Illustrator
Gonorrhea is a common sexually transmitted disease (STD) that affects both men and women, particularly young people ages 15 to 24 years. Gonorrhea is the second most commonly reported notifiable disease in the United States, with more than 550,000 cases reported in 2017. If untreated, gonorrhea infection can lead to pelvic inflammatory disease, ectopic pregnancy, infertility, and an increased risk of HIV infection. Pregnant women can pass the infection to their babies, who can become blind or develop life-threatening infections as a result.
Gonorrhea is caused by the bacterium Nesseria gonorrhoeae, which has progressively developed resistance to each of the antimicrobials used to treat it. As a result, in 2015, the U.S. Centers for Disease Control and Prevention revised gonorrhea treatment guidelines to recommend dual therapy with injectable ceftriaxone and oral azithromycin to reduce the emergence of resistance to ceftriaxone.
Zoliflodacin (formerly known as ETX0914 and AZD0914), developed by Entasis Therapeutics based in Waltham, Massachusetts, represents a new type of oral antibiotic that inhibits DNA synthesis in a different way than currently approved antibiotics.
“The rate of reported gonorrhea cases in the United States has increased 75 percent since the historic low in 2009, and antibiotic resistance has considerably reduced the number of treatment options for this disease,” said NIAID Director Anthony S. Fauci, M.D. “These encouraging research findings published today suggest that zoliflodacin has the potential to be a useful and easy-to-administer oral antibiotic for treating gonorrhea.”
The study took place from November 2014 through December 2015 and was led by Stephanie N. Taylor, M.D., of Louisiana State University Health Sciences Center in New Orleans. Study investigators recruited patients from sexual health clinics there and in Seattle; Indianapolis, Indiana; Birmingham, Alabama; and Durham, North Carolina. The trial enrolled 179 participants (167 men and12 non-pregnant women) ages 18 to 55 years with either symptoms of uncomplicated urogenital gonorrhea, untreated urogenital gonorrhea or sexual contact with someone with gonorrhea within 14 days before enrollment. Participants were randomly selected to receive either a single 2 or 3-gram dose of oral zoliflodacin or a 500-milligram (mg) dose of injectable ceftriaxone. Among the 117 per-protocol participants who were evaluated six days after treatment, 98 percent (48 of 49 participants) of those who received the 2-gram zoliflodacin dose, 100 percent (47 of 47 participants) of those who received the 3-gram dose, and all (21 of 21) of the participants in the ceftriaxone group were considered cured of their urogenital gonorrhea based on culture results.
Zoliflodacin cured all rectal gonorrheal infections (4 of 4 participants who received the 2-gram dose and 6 of 6 participants who received the 3-gram dose) as did ceftriaxone (3 of 3 participants). However, the investigational drug did not fare as well in treating patients with gonorrhea infections of the throat (pharyngeal): 67 percent of volunteers who received the 2- gram dose (4 of 6 participants) and 78 percent of those who received the 3-gram dose (7 of 9 participants) were cured. All of the participants (4 of 4) in the ceftriaxone group achieved a cure.
The investigational antibiotic was well tolerated with transient gastrointestinal upset the most commonly reported adverse effect. Microbiological evaluation of post-treatment clinical isolates did not demonstrate resistance to zoliflodacin.
In March 2018, NIAID completed a study to evaluate zoliflodacin’s pharmacokinetics, safety and tolerability as a single oral dose to serve as a bridge from the Phase 2 clinical trial formulation to the final formulation for Phase 3 testing. Results from that study have not yet been made public. Additionally, in September 2018 NIAID launched a Phase 1 study to evaluate the investigational drug’s cardiac effects, a standard safety test for new drugs such as this.
Zoliflodacin has been awarded fast track status by the U.S. Food and Drug Administration for development as oral treatment for gonococcal infections. It is expected to begin Phase 3 testing in the Netherlands, South Africa, Thailand and the United States next year.