Monkeypox

Monkeypox is still spreading in many countries, Sweden included, even if the spread has slowed down. The group most affected so far are men who have sex with men. Preventive vaccination has started in Stockholm, so far only to men who have sex with men and with several sexual partners. When Stockholm receives lager allotments of vaccine, all within the group of men who have sex with men will be offered vaccination.

Monkeypox is a fairly new disease and very little is know about it. Healthcare is constantly learning more about the course of the disease, routes of transmission, appropriate treatments, etc.

What we know today

This text (Swedish version) has been reviewed and approved by SöS/Venhälsan on 2 September 2022.

  • Monkeypox is a highly contagious disease!
  • The infection is easily transmitted from person to person.
  • It is transmitted through contact skin to skin, skin to mucous membrane, and mucous membrane to mucous membrane, through saliva and probably also semen. There are indications that the virus can also be spread via bedding and towels.
  • It is contagious during sex. Condoms only provide limited protection – you can still have skin-to-skin contact on areas not covered by the condom.
  • For most people, it takes 4-8 days before you feel or see any symptoms. For some, it can take up to three weeks.
  • Common symptoms are fever, muscle and joint pain, swollen lymph nodes and rashes which can appear anywhere on the body – not necessarily where the body contact was.
  • Those who get the rash in mucous membranes (anal/bowel, throat, mouth) often suffer from very severe pain. Until the end of July, approx. 10% of those infected in Stockholm had to be hospitalised for pain relief, drips and sometimes intravenous antibiotics du to various complications.
  • In the media it is sometimes said that monkeypox is a mild disease. This is true in comparison with, for example, smallpox, Ebola and covid-19 (in people at risk, e.g. the elderly), which are all fatal infections. However, it is not at all true that the disease is mild in comparison to the usual sexually transmitted infections (eg chlamydia, gonorrhoea and syphilis)! For being a sexually transmitted infections, monkeypox is an unusually aggressive infection, causing great suffering and discomfort to some. We have not yet seen the full consequences of the spread but are still in an early phase. Both Venhälsan and all authorities take this outbreak very seriously.
  • This disease always goes away by itself, in most cases within about 2-4 weeks, but there are occasional cases that have taken longer than that. Antiviral medicin can be given to hospitalised persons in very severe cases, but the medicine has many side effects and is reserved for life-threatening cases.
  • There are vaccines that protects against both smallpox and monkeypox. It is not known for sure whether those who were vaccinated against smallpox until the late 1970s still have any protection against monkeypox.
  • Before the current outbreak of monkeypox started, there was only a minimal production of smallpox vaccine because smallpox was effectively eradicated 40 years ago. The pharmaceutical industry will start to manufacture a new vaccine, but it will take a couple of months to adjust the manufacturing and grow the vaccine.
  • Sweden has received a very small allocation of the smallpox vaccine that exists and is distributed by the Public Health Agency (Folkhälsomyndigheten).
  • Post-exposure vaccination for monkeypox. The vaccine can currently, as a rule, only be given to people who have been identified via contact tracing and can be reached within 4 days from the suspected moment of infection (post-exposure prophylaxis). The purpose of this is only to alleviate the symptoms of the disease. If a person has started to have suspicious symptoms, the vaccine has no effect at all and must not be given!
  • Preventive vaccination for monkeypox. Vaccination for preventive purposes will start to be given in September 2022. There is no waiting list for this, but Venhälsan will help to identify people who become eligible for preventive vaccines. As vaccine availability is currently limited, priority will probably be given to people who are HIV-positive or take PrEP, and who have sexual risk behaviour. It is not yet decided who will give the vaccine doses, but Venhälsan will somehow be involved. It is also not decided how invitations to vaccinations will be made, but it could possibly be through the “Always open” (Alltid öppet) app, so it might be good to download this and make sure it works. When larger amounts of vaccine are delivered to Sweden in the future, vaccines will be offered to all within the group of men who have sex with men.
  • Monkeypox is a public hazard disease and therefore falls under the Infectious Diseases Act (Smittkyddslagen). That means that it is notifiable, infection tracing is carried out and you must follow the doctor’s prescriptions and other instructions (written information). As a rule, this normally means isolation at home until the symptoms have completely passed, and you are also not allowed to have sex during that time. If you have been exposed to monkeypox and there is a high risk of contracting it, you must also not have sex during the incubation period, i.e. 3 weeks. Even in these cases will you be given written instructions that must be followed.
  • At the moment (September) you can only be tested for monkeypox at Venhälsan and the Specialist Clinics for Sexual Health at SöS (Södersjukhuset hospital) and Huddinge Hospital (both belong to the Skin Clinic at Karolinska University Hospital). It is likely that during the fall of 2022 you will be able to test yourself for monkeypox at other sexual health clinics in Stockholm as well. There is still no way to test whether you are a symptom-free carrier of the virus or whether you are already immune. Maybe such tests will come in the future.

What does SLM Stockholm do?

  • We have a close collaboration with Venhälsan at Södersjukhuset Hospital and receive regular updates and information about the situation. We monitor and follow developments closely.
  • We care about the safety and security of our members and volunteers. We have therefore chosen to temporarily close our play areas (Dark rooms) provisionally until the mid of September. This is to, among other tings, not encourage anonymous sex and unnecessary crowding where unwanted body contact can occur more often. Our play areas are reopened, with slight increased background lightning, from Friday 16 September.
  • We are actively working to spread and provide accurate information about this virus.
  • We have assessed that we do not need to make any other changes today to our regular events.
  • Our special interest groups have, in cases where they deemed it necessary, made certain changes. For example our Naked group has cancelled their event nights until further notice.

What can you do?

  • Take care of yourself, your loved ones, your friends, and our members and volunteers.
  • Consider the risks of infection, especially in contact with casual partners, whom you may not know before.
  • If you show any symptoms, or suspect you might have been infected – stay home and contact the health services on 1177.
  • Monkeypox is very contagious and you might be a carrier even if you don’t show any symptoms!!

More information (mostly in Swedish)