NEW YORK (AP) – The spread of monkeypox in the United States could represent the dawn of a new sexually transmitted disease, although some health officials say the virus that causes pimple-like bumps may still be content before it is firmly established.
Experts disagree about the disease’s likely path, and some fear it is becoming so widespread that it is on the verge of becoming a mainstream STD, like gonorrhea, herpes and HIV.
But no one is sure, and some say testing and vaccines may yet prevent the outbreak from taking root.
So far, more than 2,400 cases have been reported in the United States as part of an international outbreak that emerged two months ago.
Health officials are unsure how quickly the virus has spread. They only have limited information about people who have been diagnosed and don’t know how many infected people could be unknowingly spreading it.
They also don’t know how vaccines and treatments work. One impediment: Federal health officials lack the authority to collect and connect data on who has been infected and who has been vaccinated.
With such big question marks, predictions about how big the U.S. outbreak will be this summer vary widely, from 13,000 to perhaps more than 10 times that number.
Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said the government’s response is getting stronger and vaccine supplies will increase soon.
“I think we still have a chance to contain this,” Walensky told The Associated Press.
Monkeypox is endemic in parts of Africa, where people have been infected by bites from rodents or small animals. It does not usually spread easily between people.
But this year more than 15,000 cases have been reported in countries that historically do not see the disease. In the United States and Europe, the vast majority of infections have occurred in men who have sex with men, although health officials have stressed that anyone can catch the virus.
It is spread mainly by skin-to-skin contact, but it can also be spread through bedding used by someone with monkeypox. While it has been moving through the population as a sexually transmitted disease, officials have been watching for other types of spread that could expand the outbreak.
Symptoms include fever, body aches, chills, fatigue, and throbbing in body parts. The disease has been relatively mild in many men and no one has died in the US, but people can be contagious for weeks and the lesions can be extremely painful.
When monkeypox first emerged, there was reason to believe that public health officials could control it.
Telltale bumps should have made infections easy to identify. And because the virus spreads through close personal contact, officials thought they could reliably track its spread by interviewing infected people and asking who they had been intimate with.
It wasn’t that easy.
With monkeypox so rare in the United States, many infected men and their doctors may have attributed their rashes to some other cause.
Contact tracing was often hampered by infected men who said they did not know the names of all the people they had sex with. Some reported having multiple sexual interactions with strangers.
It didn’t help that local health departments, already burdened with COVID-19 and dozens of other diseases, now had to find the resources to do intensive contact tracing work with monkeypox as well.
Indeed, some local health officials have given up expecting much from contact tracing.
There was another reason to be optimistic: the US government already had a vaccine. The two-dose regimen called Jynneos was licensed in the US in 2019 and was recommended last year as a tool against monkeypox.
When the outbreak was first identified in May, US officials had only about 2,000 doses available. The government distributed them, but limited the shots to people who were identified through public health investigations as having been recently exposed to the virus.
Late last month, as more doses became available, the CDC began recommending that vaccines be offered to those who realize on their own that they may have been infected.
Demand has outstripped supply, with clinics in some cities quickly running out of vaccine doses and health officials across the country saying they don’t have enough.
That is changing, Walensky said. As of this week, the government has distributed more than 191,000 doses, and has 160,000 more ready to ship. Up to 780,000 doses will be available next week.
Once current demand is met, the government will look to expand vaccination efforts.
The CDC believes that 1.5 million American men are considered at high risk of infection.
Testing has also been expanded. More than 70,000 people can be tested each week, far more than current demand, Walensky said. The government has also embarked on a campaign to educate doctors and gay and bisexual men about the disease, he added.
Donal Bisanzio, a researcher at RTI International, believes that US health officials will be able to contain the outbreak before it becomes endemic.
But he also said that this will not be the end. New outbreaks of cases are likely to emerge as Americans become infected by people in other countries where monkeypox continues to circulate.
Walensky agrees that this scenario is likely. “If it’s not contained worldwide, we’re always at risk of outbreaks” from travelers, he said.
Shawn Kiernan of the Fairfax County Health Department in Virginia said there is reason to be tentatively optimistic because so far the outbreak is concentrated in one group of people: men who have sex with men.
The spread of the virus to heterosexual people would be a “tipping point” that could happen before it is widely recognized, said Kiernan, head of the department’s communicable diseases section.
The spillover to heterosexuals is only a matter of time, said Dr. Edward Hook III, professor emeritus of infectious diseases at the University of Alabama at Birmingham.
If monkeypox becomes an endemic sexually transmitted disease, it will further challenge health departments and doctors who are already struggling to keep up with existing STDs.
This work has long been underfunded and understaffed, and much of it was simply put on hold during the pandemic. Kiernan said HIV and syphilis were prioritized, but work on common infections such as chlamydia and gonorrhea meant “counting cases and that’s it.”
For years, cases of gonorrhea, chlamydia and syphilis have been increasing.
“In general,” Hook said, doctors “do a poor job of taking sexual histories, of investigating and recognizing that their patients are sexual beings.”
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Associated Press writer Janie Har in San Francisco contributed to this report.
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The Associated Press Department of Health and Science is supported by the Department of Science Education at the Howard Hughes Medical Institute. The AP is solely responsible for all content.