The fall semester is starting soon and colleges will have yet another public health challenge to navigate: monkeypox.

Over the summer, some universities started posting information about the disease online and hosted virtual Q&A sessions to clarify how the virus spreads and dispel misconceptions.

In the current outbreak, monkeypox has mostly spread within networks of men who have sex with men. But that’s a fluke, driven by the virus happening to land in this community first. Anyone can get it through skin-to-skin contact with monkeypox sores, other close contact with someone who is infected, or by touching contaminated clothes or bedding. In New York City, people who identify as straight made up 2.6% of cases as of Thursday — nearly double the percentage reported a week ago.

College students, who often live and socialize in close quarters, may be at higher risk.

“College students may have some elevated risk because of how they socialize and the fact that they may be more likely to be in densely populated classrooms or social events or dormitories or parties,” said Dr. Debra Furr-Holden, dean of NYU’s School of Global Public Health. “And, while monkeypox is not an STD, sexual activity involves close, personal contact,” which can lead to transmission.

In addition to NYU’s Furr-Holden, Gothamist spoke with public health experts from Columbia University and CUNY to ask about the best way to keep college students safe without inciting panic.

“We have a pretty unique opportunity with college students [to spread awareness about monkeypox] because, in a sense, they're a captive audience,” Furr-Holden said. “They're getting the university-wide communications and they're also getting the university protocols and wrapped in the protocols is messaging.”

Furr-Holden and others who spoke to Gothamist said it’s important to make students aware of symptoms and methods of transmission. They’re also encouraging people to stay home if they're sick.

A health alert posted about monkeypox on the NYU website highlights the symptoms students should look out for, going beyond the signature lesions associated with the disease. It notes that symptoms may include “fever, headache, muscle aches and backache, swollen lymph nodes, chills, exhaustion, and a rash that can look like pimples or blisters,” and says anyone noticing those symptoms should contact the student health center and isolate themselves.

Meanwhile, in a July 29th post about monkeypox, Columbia encouraged students to prevent the spread by asking sexual partners whether they have a rash or other symptoms of monkeypox; avoiding skin-to-skin contact with someone who has monkeypox symptoms; and not sharing bedding, towels, clothing, or utensils with a person who has monkeypox. The Centers for Disease Control and Prevention recommend that monkeypox patients disinfect surfaces at home.

The Columbia University campus.

The Columbia University campus.

The Columbia University campus.
Sergi Reboredo/VW Pics/Universal Images Group via Getty Images

The city health department says the monkeypox outbreak is mainly spreading through sex as well as other intimate activities such as kissing or cuddling.

But when communicating with college students, it’s important to strike a balance between indicating the risks associated with sexual activity and making it clear that people don’t have to have sex to catch monkeypox, said Dr. Ayman El-Mohandes, dean of CUNY’s Graduate School of Public Health and Health Policy.

“If you say monkeypox is a sexually transmitted infection, somebody will say, ‘Well, I haven't had sex with anybody in the last two weeks. I shouldn’t worry about the fever that I have today … This couldn’t possibly be monkeypox,’” El-Mohandes said.

El-Mohandes and others who spoke to Gothamist highlighted the need to avoid stigmatizing the disease — a challenge that has created divides within the public health community over what messaging to use.

Such stigma “can be very detrimental for the individual himself or herself, and can really delay people from coming forth and getting diagnosed and getting the treatment they need,” said Dr. Wafaa El-Sadr, an infectious disease expert at Columbia University who is among those who have been consulted on their approach to the monkeypox virus.

NYU’s guidance emphasized discretion when it comes to dealing with a known or suspected case of monkeypox. It said faculty or students aware of a case “should not make announcements, notify others about the case, cancel classes, and/or make health recommendations to other members of the NYU community.”

Speaking about that portion of NYU’s health alert, Furr-Holden said, “We have to really be very conscious about the balance between making sure that we are giving people information to be able to protect themselves versus creating hysteria. It's a complex balance, but I think it's one that not just NYU, but all universities are going to have to figure out.”

She added that the biggest lesson to take away from the COVID-19 response is that guidance and protocols will have to evolve along with the disease and what scientists know about it.