The Centers for Disease Control and Prevention released data finding the monkeypox outbreak is concentrated among men who have had sex with several men, and issued more detailed recommendations on how to avoid exposure to the disease.
Among 291 men surveyed, 40% reported that they had two to four partners and 14% reported five to nine partners in the three weeks before developing monkeypox, according to the report. About 19% reported 10 or more partners during that period, the CDC said Friday.
And among 86 men who reported information, 28% said they had had group sex, which is defined as sex with more than two people, at a festival, group sex event or sex party, based on the report. The research was conducted from May 17 through July 22.
After releasing the data, the CDC also issued more specific warnings and recommendations for reducing the risk of monkeypox than its earlier guidelines. The CDC also extended its recommendations to anyone sexually active, not just those who suspect they are infected.
In addition to advising people to limit their number of sex partners, the CDC recommended wearing latex, polyurethane or nitrile gloves, and changing or cleaning clothes, bedding, towels and sex toys after sex.
The new developments come after cases increased to more than known 7,000 in the U.S., prompting the federal government to declare a public-health emergency.
Monkeypox is a viral disease that can spread to anyone through close, personal contact that is often skin-to-skin as well as contact with respiratory secretions, direct contact with rash or scabs, and touching objects used by someone with the virus, the CDC said.
Direct contact can happen during sex or touching of genitals, as well as kissing, hugging, massage, and touching fabrics and objects used during sex such as fetish gear, according to the agency.
Scientists are still researching if monkeypox can be spread through semen or vaginal fluids. Monkeypox DNA was present in semen in one study of Italian men conducted in May, but health experts have said they don’t know for sure if that means the virus can transmit sexually.
While anyone can get monkeypox, the CDC said in June that the outbreak may be concentrated among gay and bisexual men because the virus is taking advantage of social and sexual networks in that group.
Yet health authorities had held off on some direct warnings out of fear of stigmatizing the population, according to people familiar with the discussions.
The release of the data and guidelines suggests a new phase in the response, however, with the Biden administration speaking more directly about who is at risk and how they can reduce it.
Government officials expressed hope that the new recommendations could help slow the spread of the virus by getting through to people most at risk. Shortages of tests, vaccines and drugs have hurt the effort and drawn criticism from some doctors and health experts.
“Given the current limited supply of vaccine, CDC recommends temporarily changing some behaviors that may increase a person’s risk of being exposed,” an agency spokeswoman said. “These temporary changes will help slow the spread of monkeypox until vaccine supply is adequate.”
Even people who feel well, the CDC said, should consider such steps as limiting the number sex partners, having sex with clothes on and covering areas where a rash is present. Aside from recommending gloves to reduce exposure, the CDC also described the benefits of wearing leather or latex gear.
U.S. health authorities have struggled with how to communicate about the virus that is hitting communities already subject to historical discrimination.
Federal officials had been careful to avoid warnings that they think would lead to stigma of certain sexual activities, but such caution has led to criticism that government leaders are being unclear and that messages aren’t getting through to people most at risk for the virus.
“They are harming the very group they’re trying so hard not to stigmatize,” said Dr. Greg Poland, head of the Mayo Clinic’s Vaccine Research Group.
Absent detailed recommendations from the federal government, LGBT activists had written their own guidelines for safe sex. One guide advised against group sex in public places and recommended creating pods of small groups men who would only have sex with each other.
“I think the CDC should be saying the truth,” said David Kilmnick, president and founder of the New York LGBT Network, who praised the new recommendations. “We have to be direct and real and not sugarcoat anything.”
The head of the World Health Organization warned in late July that men who have sex with men should limit their number of sexual partners, think twice about sex with new people and exchange contact information when they do have sex.
The Biden administration had initially adopted a strategy known as ring vaccination that has often worked in instances of household transmission. The approach focuses on vaccinating contacts of confirmed patients and people who had close contacts with those people.
This monkeypox outbreak has instead been centered in sexual networks, according to one federal official. An effort was made to do contact tracing, the person said, but the number of contacts was “significantly greater and often anonymous.”
Because of the challenge, the official said, the administration abandoned the initial ring vaccination strategy and moved instead to encouraging people who may have been exposed or had multiple partners in areas of high monkeypox transmission to get vaccinated.
The administration sought to conduct outreach during the recent Pride month. The CDC on June 2 began conversations with Interpride, a group that organizes Pride events throughout the country, to share information about monkeypox with event organizers and attendees. It also joined with sites such as Grindr to spread warnings about monkeypox.
The CDC in June also worked with social-media influencers such as
Shea Coulee,
a drag queen, musician and podcaster and social-media platforms to get messages on monkeypox out to followers and users.
Monkeypox can cause symptoms such as fever, chills, exhaustion, headache, sore throat and a rash. Some cases of monkeypox are mild, but others come with excruciating rectal pain or swelling. The symptoms usually appear within three weeks of exposure. The illness typically lasts two to four weeks. CDC recommends the infected isolate for the duration of their illness.
Write to Liz Essley Whyte at liz.whyte@wsj.com and Stephanie Armour at stephanie.armour@wsj.com
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