[metta]

The transmission of monkeypox is more likely to occur during anal intercourse and oral sex than during non-traumatic contact with healthy keratinized skin.

The first thing is to look at the most likely source of infection (i.e, where pathogen load is higher). A pathogen may be mainly transmitted from semen or blood (e.g., hepatitis, HIV, etc.) or from purulent lesions (e.g., syphilis, chancroid, herpes); MPXV mostly the latter.

Second, virus entry into a new host is dependent on a defective skin barrier or wound. As a result, the virus cannot penetrate the stratum corneum of normal, healthy skin, but easily penetrates superficial abrasions in the mucosa resulting from mild trauma during sex.

There are different levels of trauma and skin abrasions associated with different types of skin-to-skin contact, and in this regard, “sexual skin-to-skin contact” is more traumatic than other types of non-sexual skin-to-skin contact.

Though I am not an expert on risk communication, monkeypox-prevention messaging should possibly indicate sexual contact as the current primary mode of transmission.

However, it is good to remember that STIs such as syphilis or chancroid are commonly found in children (in the form of yaws or cutaneous chancroid) in the tropics where abrasions on the arms and legs are common. I would not rule bridging to new key populations in the future.

https://twitter.com/oriolmitja/status/1559605763395538945