Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022

Abstract

Since May 2022, an outbreak of monkeypox has been ongoing in non-endemic countries. We report four cases in Italy in young adult men reporting condomless sexual intercourse. The patients are in good clinical condition with no need for specific antiviral drugs. Biological samples from seminal fluid were positive for monkeypox viral DNA. For many other viruses found in semen there is no evidence of sexual transmission. The possibility of sexual transmission of monkeypox virus needs to be investigated.

A viewpoint: The 2022 monkeypox outbreak

“…Phylogenetic analyses of the whole genome sequences from a number of countries during the current outbreak suggest that circulating viruses are closely related to each other and to previous MPX infections described in West Africa, and in travellers from that region. 1 , 15 Further ongoing collection and analysis of the full viral genome sequences will be important to understand whether these have originated from multiple introductions or have been circulating but undetected outside of ‘endemic’ areas.…”

“…The clinical spectrum documented so far points towards a milder form of the illness than the one in documented cases in Africa, with a more subtle and variable rash, often involving the ano-genital regions and not always associated with the systemic symptoms classically associated with MPX. 15 Deaths have not been reported outside endemic areas. 7 , 12 …”

“…Although not classically described as a sexually transmissible infection (STI), monkeypox can be transmitted through intimate contact. 15 , 19 It is known that there is a viremic period and that the virus can also be detected in semen, although their role in terms of transmission remains unknown. 15 Moreover, it is as yet unknown, whether like some other viruses - e.g, Ebola, Lassa 20 , 21 MPX can establish reservoirs in the uro-genital tract with a potential for transmission after the skin and mucosal lesions have healed.…”

Letter to the editor: multiple introductions of MPX in Italy from different geographic areas

“…To the editor: In last week’s issue of Eurosurveillance , Antinori et al [ 1 ] comprehensively described the first four cases of monkeypox detected in Rome, all of them in men who have sex with men (MSM) presenting with ano-genital rash, and who had travelled to other European countries. Here we share some considerations on the need to also take into account the possibility of monkeypox virus (MPXV) introduction from non-European countries during the course of the current outbreak, as suggested by the epidemiological investigations conducted in Italy on further confirmed recent monkeypox cases.…”

Monkeypox Virus Outbreaks and Poxvirus Infections: Transmission Routes and Epidemiological Characteristics

“…Olgu sayısının artması ile ortaya çıkan yeni kanıtlar da bu öngörüyüdestekler niteliktedir[43,44]. Bu salgında, cinsel ilişki sırasında virüs içeren deri lezyonları ile yakın temas sonrası enfeksiyonun hasar görmüş cilt ve mukozalardan bulaştığı öngörülmektedir[39,45] [6]…”