An emerging outbreak of monkeypox infection is quickly spreading worldwide, being currently reported in more than 30 countries, with slightly less than 1000 cases. In the present preliminary report, we collected and synthesized early data concerning epidemiological trends and clinical features of the ongoing outbreak and we compared them with those of previous outbreaks. Data were pooled from six clusters in Italy, Australia, the Czech Republic, Portugal, and the United Kingdom, totaling 124 cases (for 35 of which it was possible to retrieve detailed information). The ongoing epidemic differs from previous outbreaks in terms of age (54.29% of individuals in their thirties), sex/gender (most cases being males), risk factors, and transmission route, with sexual transmission being highly likely. Also, the clinical presentation is atypical and unusual, being characterized by anogenital lesions and rashes that relatively spare the face and extremities. The most prevalent sign/symptom reported was fever (in 54.29% of cases) followed by inguinal lymphadenopathy (45.71%) and exanthema (40.00%). Asthenia, fatigue, and headache were described in 22.86% and 25.71% of the subjects, respectively. Myalgia was present in 17.14% of the cases. Both genital and anal lesions (ulcers and vesicles) were reported in 31.43% of the cases. Finally, cervical lymphadenopathy was described in 11.43% of the sample, while the least commonly reported symptoms were diarrhea and axillary lymphadenopathy (5.71% of the case series for both symptoms). Some preliminary risk factors can be identified (being a young male, having sex with other men, engaging in risky behaviors and activities, including condomless sex, human immunodeficiency virus positivity (54.29% of the sample analyzed), and a story of previous sexually transmitted infections, including syphilis). On the other hand, being fully virally suppressed and undetectable may protect against a more severe infectious course. However, further research in the field is urgently needed.

An outbreak of monkeypox, a rare zoonotic disease caused by an orthopoxvirus, is currently ongoing and has spread so far to more than 20 countries, mostly affecting Europe, the Americas, Australia, and Israel, with more than 400 confirmed cases (https://bnonews. com/monkeypox/), becoming the largest monkeypox epidemic outside of western and central Africa, where it is endemic in eleven countries. 1 In the UK, where the first monkeypox case was reported on May 7, 2022, in a traveler returning from Nigeria, the National "Health Security Agency" (UKHSA) has reported that "a notable proportion of early cases detected have been in gay and bisexual men and so UKHSA is urging this community in particular to be alert" (https://www.gov.uk/government/news/monkeypox-casesconfirmed-in-england-latest-updates). Moreover, the "European Centre for Disease Prevention and Control" (ECDC) has stated that "the majority of cases have been in young men, many self-identifying as men who have sex with men (MSM)" (https://www.ecdc.europa.eu/ en/news-events/epidemiological-update-monkeypox-outbreak).These statements have been promptly relaunched by media and social networks, some of which have morbidly covered some events and festivals, like the "Gay Pride Maspalomas (Gran Canaria) 2022", held from May 5 to May 15, 2002, in Maspalomas, Great Canary (Spain), where about 80 000 people met from across the European

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Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatised and experience discrimination in healthcare settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ+ communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ+ people experience stigmatisation and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing healthcare services, and fewer tailored interventions being provided. These findings have implications for policy, healthcare screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental healthcare providers can challenge social issues that maintain discriminatory and stigmatising practices, and support LGBTIQ+ individuals to sustain their resilience. Table 2. Characteristics of included studies (without a review design)*