Dear Editors,

According to an article published on the official website of the World Health Organization (WHO), outbreaks of a disease called “monkeypox” are currently occurring in countries that usually have no cases. This observation differs from the epidemiology of African subjects, where they are associated with people and professionals who handle infected animals, with few reports of inter-human transmission. This disease seems to be related to gays, bisexuals, and men who have sex with men1.

This hypothesis of sexual transmission involving specific populations should be investigated, once the ways of transmission of the virus is related to intimate contact with lesions and respiratory secretions (sprays, that is, large droplets). As sex is perhaps one of the forms of greater intimacy in relationships between people, the number of partnerships with infected people or with people from endemic areas should become an important matter to prevent, regardless of sexual options. Preventive measures taken against STIs, such as male and female condoms will not be effective for monkeypox.

The orientation of sexual abstinence for people who circulate in endemic areas or have contact with suspected cases (to avoid skin-to-skin contact), the use of masks (to avoid contact with secretions from the respiratory tract) become necessary measures, and it is already known, but not always followed, through experiences with other STIs. Given this, we propose a reflection on what measures should be taken by health professionals, government agencies, research institutions, and the general population due to the premise of this possible future pandemic.

According to the WHO, epidemics occur when there are cases of disease or health-related events and behaviors that amplify beyond expectations. According to the Centers for Disease Control and Prevention of the United States of America (CDC-USA), a pandemic is a process arising from an epidemic in wide geographical distribution, covering a large part of the population of several countries or continents2.

Throughout the 20th and 21st centuries, several epidemics and pandemics ravaged the world, such as the Spanish flu, tuberculosis, cholera, Zika virus, coronavirus, and AIDS, some of which are even sexually transmitted and associated with prejudice and neglect of public health3.

After the emergence of Covid-19 in China and the prediction of the potential danger of the disease spreading worldwide, it is known that there has been some limitation and hesitation in the strategies to face this possible pandemic by national defense agencies4. In addition, it is important to highlight that the pandemic in question may have had more severe repercussions in the context of socio-spatial inequality in vulnerable territories5.

United Kingdom is one of the countries where the monkeypox has spread in 2022. The UK Health Security Agency (UKHSA) says that although the disease has not previously been classified as a sexually transmitted infection, there is evidence of sexual transmission6.

According to some authors, this disease that emerged in 1970 and currently spread to several countries in North America and Europe, including Australia and Israel, had cases detected in a remarkable proportion in the LGBTQIA+ population7.

The WHO states that this population should be alert to the symptoms of the disease, which include skin rashes, fever, headache, myalgia, fatigue, and lymph node enlargement. In addition, disease prevention should be promoted through isolation and contact avoidance with supposedly exposed individuals, adoption of safe sexual practices, including the use of condoms1,2,3,4,5,6,7.

In Brazil, the newspaper “O Globo” issued an article on May 30, 2022, warning about the investigation of a possible case of the disease in Porto Alegre (RS), also highlighting that the Ministry of Health monitors two other suspected cases8. It is very likely that until the publication of this document, the number of suspected or proven cases will be different.

Faced with a possible epidemic or even a pandemic caused by the monkeypox, and considering a possible sexual transmission, it is relevant for national and international health authorities to question what measures to adopt in order to contain the disease and not repeat the mistakes of previous situations.

Monkeypox is a zoonosis caused by Orthopoxvirus, similar to the smallpox virus in humans, which was eradicated in the 1980s through vaccines9. Anyone who has taken this vaccine has about 85% protection against the monkey virus. Therefore, people under the age of 45 are more vulnerable. Is it time to re-administer this vaccine in this population? However, researchers and military personnel who go to conflict areas are vaccinated, as the smallpox virus is considered a biological weapon. There is cross-protection for viruses of the Orthopox genus (smallpox, monkeypox, vaccinia, and cowpox).

Sexually transmitted infections are intrinsic to contexts of vulnerability, mainly socioeconomic and cultural10, and their controls involve all segments of society, in addition to health, once STIs mostly occur with intimate contact with different body parts and great possibilities for exchanges of respiratory droplets. However, the agent of monkeypox is not known to be eliminated by semen.

Dear Editors, we decided to first send this concern of ours to the Brazilian Journal of Sexually Transmitted Diseases since we believe that this reliable scientific journal, indexed, peer-reviewed, the only one open on the internet in the area, has great reach and has a tradition of presenting current and reflective texts.