Study: Monkeypox: Another Sexually Transmitted Infection? Image Credit: Dotted Yeti / Shutterstock.com

Should Monkeypox be considered a sexually transmitted infection?

The monkeypox virus, a zoonotic DNA virus belonging to the family Poxviridaewas first identified in the Asian Macaca fascicularis apes in Copenhagen, Denmark in 1958. This virus was first found to infect humans in 1970 when it was isolated from a nine-month-old boy in the Democratic Republic of the Congo after smallpox vaccination regulations were withdrawn from the region.

Study: Monkeypox: Another Sexually Transmitted Disease? Image Credit: Dotted Yeti / Shutterstock.com

Background

Previously, monkeypox virus was endemic to West and Central African countries. The monkeypox virus can be further divided into two clades, with the Central African (Congo Basin) clade often considered the more pathogenic clade associated with more serious diseases.

In 2003, the first monkeypox outbreak outside Africa was identified during a overflow event of wild rodents exported for pet use to the United States. During this animal-to-human transmission, children from six US states were infected.

Since 2018, several outbreaks of monkeypox virus have been reported in the United Kingdom (UK), Singapore and the US. More recently, several other outbreaks have been reported in the UK, as well as other European and non-European countries. As of June 28, 2022, more than 2,600 human monkeypox virus infections have been confirmed worldwide.

The current monkeypox outbreak

The current monkeypox outbreak is characterized by sustained human-to-human transmission, even among people who have not recently traveled to countries where the virus is endemic. In addition, many of these cases have been reported in men who have sex with men (MSM), raising concerns about the possible sexual transmission of monkeypox virus.

Some of the monkeypox cases identified during the current outbreak have been reported in individuals infected with human immunodeficiency virus (HIV), particularly in MSM populations. In addition, monkeypox virus was detected in the seminal fluid, as well as genital and rectal lesions, of four MSM patients with monkeypox infection from Italy.

Recent clinical evidence supports the likelihood that monkey pox virus sexual transmission occurred during the current outbreak. While further studies are needed to confirm global speculation, definitive evidence of infectiousness is lacking. Anyway, viral shedding and its efficiency for sexual transmission has been confirmed.

The risk of transmission of monkeypox through sexual contact highlights the need to raise awareness among the sexually active population to prevent future outbreaks. According to the European Centers for Disease Control (ECDC), vulnerable populations include those with multiple sexual partners, particularly those within the MSM and lesbian, gay, bisexual, transgender and intersex (LGBTI) community.

Is Monkeypox a Sexually Transmitted Infection?

Monkeypox infection was initially considered only zoonotic; however, interpersonal transmission of this virus through direct contact with lesions, respiratory droplets, bodily fluids and contaminated materials has been reported for several years.

The likelihood that monkeypox virus can be transmitted sexually would provide important inclusions during the evaluation of patients with HIV, as well as patients with other sexually transmitted infections (STIs) presenting with fever and lymphadenopathy followed by a vesicular-papular rash.

These considerations should also be extended to the assessment of patients with genital ulcers, especially those who have recently traveled to sites with confirmed cases of monkeypox. In particular, genital ulcers have been reported in 52 cases during the most recent monkeypox outbreak.

Preliminary data indicate that the factors that increase a person’s susceptibility to HIV infection may also increase the risk of being infected with the monkeypox virus. These risk factors include being a young man who has sex with other men, engaging in risky behaviors and activities, including unprotected (barrier-free) sex, being HIV positive, and having a history of previous STDs, such as syphilis.

prevention

Some of the approaches that can help prevent monkeypox transmission include the implementation of zoonotic disease programs, including interaction and integrated strategies with sexual health awareness and STD education. In addition, the active involvement of several national and international scientific societies can also help reduce the current monkeypox outbreak and limit its potential to become a new pandemic. Taken together, these efforts would also reduce the global public health burden imposed by STDs.

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