Why monkeypox affects mostly men

Amidst the soaring numbers of people infected with monkeypox (Mpox) disease, the latest report has revealed that men are the worst hit.

The National Mpox Situation Report of February 21, 2025, has revealed that of the 3,391 cumulative number of confirmed Mpox cases in Uganda, men constitute 56.7% (1,923) compared to their female counterparts with 43.7% (1,481). Of the 2,963 admitted patients, 2,444 have either been discharged after recovering or are about to be discharged.

“We have realised that males are more affected than females, particularly those in the age bracket of 19 to 45 years,” Dr Bernard Lubwama, the Mpox deputy incident commander at the Ministry of Health, said.

Dr Lubwama further noted that the most at-risk category is the female commercial workers who are exposing men to the disease.

“The most-at-risk group are the commercial sex workers, therefore, we are seeing their clients who are the men more affected,” he said.

He estimated that on average a commercial sex worker sees between 8 to 12 men every day.

“This implies that if we get one female commercial worker, they will on average expose six to 12 men daily, based on their estimated number of clients.”

He further explained that newer Mpox cases are appearing in urban areas where there is a high concentration of sexual networks.

The same report indicates that the disease has continued to spread across the country, covering 91 districts.

Notably, 567 new Mpox cases were reported in 14 days while a total of 59 new mpox cases were recorded in the last 24 hours before the report, with Mbarara district leading (19), followed by Kampala with five new cases.

Madi-Okollo and Ibanda recorded five new cases. Arua recorded four cases and Mukono three new cases. Wakiso, Nakasongola, Kayunga and Dokolo districts had two cases each.

Additionally, Tororo, Soroti, Rukungiri, Lira and Buikwe registered one new Mpox case each.

On a sad note, the number of patients who have succumbed to Mpox has risen to 23. Of these, 13 deceased are from Kampala. Wakiso district has so far recorded four deaths and Mukono two deaths. Kikuube, Pallisa, Nakasongola and Masindi registered one death each.

What is killing mpox patients?

The other most at risk are people living with HIV/AIDS, cancers and those whose immunity is compromised such as children and the elderly.

Dr Lubwama noted that people living with HIV/AIDS who are not on treatment are severely affected because their immune system is weakened.

Children with chronic illnesses such as sickle cell disease and the malnourished have been severely affected.

He also attributed deaths to patients delaying seeking medical care from trained health workers. To save lives, Dr Lubwama advised the public to embrace early diagnosis and treatment.

Massage parlours fuelling mpox

Dr Lubwama said there is also high-end exposure to Mpox through massage parlours and lodges where people get exposed by sharing blankets, bedsheets and towels.

“If hygiene is maintained, the spread of the disease will be controlled,” he said.

The chairperson of the Federation of Uganda Salons and Beauty Professionals, Celestine Kamanyire, said they have started sensitising salon and massage parlour owners and workers on Mpox prevention.

She said they have encouraged standard operating procedures such as the use of sanitisers and handwashing facilities. Additionally, barbers are encouraged to use medical wipes instead of hot towels.

In addition, signposts with Mpox prevention tips are being hung in strategic areas of various salons, and massage parlours. They have also started distributing condoms, Kamanyire said.

Transmission, symptoms

Mpox, previously known as monkeypox, is a viral illness caused by the monkeypox virus, a species of the genus Orthopoxvirus.

Common symptoms are a skin rash or mucosal lesions which can last two to four weeks and are accompanied by fever, headache, muscle aches, back pain, low energy and swollen lymph nodes.

Mpox spreads from person to person mainly through close contact with someone, including members of a household. Close contact includes skin-to-skin (such as touching or sex) and mouth-to-mouth or mouth-to-skin contact (such as kissing).

It can also involve being face-to-face with someone who has mpox (such as talking or breathing close to one another).

People can also contract Mpox from contaminated objects such as clothing or linen, through needle injuries in health care or community settings such as tattoo parlours.

During pregnancy or birth, the virus may be passed to the baby.

“Contracting Mpox during pregnancy can be dangerous for the foetus or newborn infant and can lead to loss of the pregnancy, or complications for the parent,” the World Health Organisation (WHO) says.

Animal-to-human transmission occurs from infected animals bite or scratch humans, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses or eating the animals.

The natural reservoir of the virus is unknown, but various small mammals such as squirrels and monkeys are susceptible, according to the WHO.

Lubwama advised avoiding contact with people who have lesions without proper protection. He said the use of condoms will not protect you, but rather keep away from sexual fluids.

“Sex is intimate and really close contact,” he explains.

Mpox patients are advised to avoid sexual activity until skin rash clears.

Those recovering from mpox should use condoms for 12 weeks (three months), according to WHO recommendations.

Background

On August 14 last year, the WHO declared Mpox a public health emergency of international concern, the second time in two years.

The global alert was preceded by a declaration by the African Centres for Disease Control and Prevention on August 13 recognising Mpox as a public health emergency of continental security. These declarations underline the seriousness of the situation and the need for concerted efforts to curb the spread of the disease.

Safety tips

Observe a high level of hygiene by washing hands regularly using soap and water, using an alcohol-based hand rub and regularly cleaning contaminated surfaces.

If you are already infected, isolate yourself so as not to infect others.

Do not share personal effects such as towels, bedding, clothing or sharp instruments; razor blades and needles, among others.

Avoid shaking hands, hugging, kissing and pecking.

Mpox is also transmitted through sexual networks. Therefore, be faithful to your spouses and partners.

Vaccination programme

Uganda received only 10,000 doses of the Mpox vaccine which were given to commercial sex workers in the Kampala metropolitan area in the most affected divisions of Kawempe and Makindye, Dr Michael Baganizi, the manager of Uganda National Expanded Programme for Immunisation, said.

Dr Baganizi further noted that the Government will soon receive more Mpox vaccine doses which will be given to the first 10,000 people to complete their second dose.

The remaining will be distributed based on the new categorisation of high-concentration areas with Mbarara district being a priority area.

Notably, a surveillance team is being dispatched to the Mbarara and Masaka region, while the response in the Kampala metropolitan area — Kampala, Wakiso and Mukono — is ongoing.

“We are not putting our guard down and we will not. We are determined to throw this disease out of our country,” health ministry official Dr Bernard Lubwama said.