Sexual health services ‘struggling to meet’ monkeypox demands

As of 7 July, there were 1,552 confirmed cases of monkeypox in the UK, including 1,482 in England.

“At the moment services do not have the capacity to manage the increasing numbers of monkeypox in an urgent way”

Claire Dewsnap

Several other countries across the globe have also reported a spike in cases since the outbreak was identified in May 2022.

Although anyone can contract the virus, latest data shows the majority of cases are in gay, bisexual and other men who have sex with men.

It is not defined as a sexually transmitted infection but can be passed on by direct contact during sex and through contact with the clothing or linen of those infected.

In an interview with Nursing Times today, the president of the British Association of Sexual Health and HIV (BASSH), Dr Claire Dewsnap, said cases were “doubling approximately every 15 to 20 days” and that the association was “really worried” about the outbreak potentially becoming endemic.

She warned of a lack of staffing, capacity and funding to help meet demands and explained how other core sexual health services were being “pushed out” as a result.

“At the moment services do not have the capacity to manage the increasing numbers of monkeypox in an urgent way,” she told Nursing Times.

“It needs to be dealt with urgently, you can't delay that activity for a week or two weeks, you need to see it now.”

She described how “most” sexual health services across the UK were “not coping well” amid the outbreak.

Health professionals were working extra hours, often unpaid, and were faced with staff shortages and insufficient resources and funding to manage the situation, added Dr Dewsnap.

“We have less staffing than we did 10 years ago, we have significantly less money in sexual health services than we did 10 years ago, we have an increasing rate of [sexually transmitted diseases] and we now have monkeypox, and we haven't been given any additional resource to manage that,” she said.

Staff are also spending “extra time” triaging all individuals who contact clinics with a rash and these patients are being seen in separate areas, which are then deep cleaned, to prevent its spread.

These processes were “causing a massive additional shift of work”, said Dr Dewsnap, who is also a genitourinary medicine consultant in Sheffield.

For Dr Dewsnap, she was seriously worried about nursing staff, as well as doctors, many of whom had been redeployed during the height of the coronavirus pandemic, and were now having work under further “challenging” circumstances.

“All of the staff [are] so well trained and so able, and we just need the funding and the support to be able to do our jobs”

Jodie Crossman

They were also once again having to work in new ways and were “learning as we go” as the UK has not had a past outbreak of monkeypox, she noted.

“The nurses and the doctors are doing their very best to make sure we put patients first, but we need more staff,” she added.

Meanwhile, Jodie Crossman, chair of the BASSH Sexual Health Adviser and Nurse Special Interest Group, agreed teams were “struggling” in terms of capacity and with spaces to see and treat patients with monkeypox.

The situation was made worse by staff shortages, largely driven by the latest surge in Covid-19 cases which has increased the number of staff absences.

Nurses are feeling “tired” and are still trying to recover from the demands of the pandemic, including redeployment, Ms Crossman told Nursing Times.

“It was starting to feel like things were getting a bit more stable, but this has just added pressure on top of an already pressured NHS,” she said about the monkeypox outbreak.

She added: “All of the staff [are] so well trained and so able, and we just need the funding and the support to be able to do our jobs.”

Ms Crossman, who is also a nurse team leader for a sexual health service in Brighton, said there were different rates of monkeypox infection across the UK, but that London was being “hit the worst”.

She was aware of some services in the capital “severely” reducing their offering for other sexual health services because of the monkeypox demand.

Some sexual health services in the UK were also taking on the task of administering monkeypox vaccinations, which was causing an additional strain on capacity, she said.

Last month it was confirmed by the UKHSA that vaccines should be offered to gay and bisexual men at higher risk of exposure to monkeypox.

Pre-exposure vaccination for health workers, including nurses, who are expected to provide care to patients with monkeypox or who may be exposed to materials contaminated with the virus, should also be “prioritised”, under the UKSHA’s guidance.

Ms Crossman explained that vaccine access for staff working in sexual health clinics was currently “quite limited”.

“Only some of our staff has been able to access that,” she told Nursing Times.

Dr Andrew Lee, UKSHA incident director, said: “Our surveillance systems were the first in the world to detect the current outbreak and we have worked at pace with partners across the health system and third sector organisations to detect cases, identify and isolate contacts and procure vaccine to protect those at highest risk.

“We have rapidly mobilised a large-scale national response with sexual health services, to investigate and control monkeypox and to support those affected.

“Sufficient vaccine supplies are available, enabling the NHS to roll out the programme to high-risk groups.”

An NHS spokesperson added that the health service would be “rapidly” growing the number of vaccination clinics in wake of the outbreak.

Those “at greater risk, including healthcare workers in specialist roles and clinics where exposure to monkeypox is highest” would also be prioritised, they added.