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outbreak of the monkeypox (MPX) virus and Siddiqui et al. 2 highlighted the current challenges of the ongoing epidemic, which include a lack of available treatment options for severe cases. Currently, little evidence supports antiviral therapy with cidofovir or tecovirimat for the treatment of severe MPX cases. 3,4 In this letter, we present the use of cidofovir for the treatment of hospitalized severe MPX cases.Overall, four men who have sex with men diagnosed with MPX infection between June and August 2022 at the Infectious Diseases Unit of San Raffaele Scientific Institute, Milan, Italy, were treated with cidofovir following hospitalization. Individual characteristics are presented in Table 1. Two individuals were living with human immunodeficiency virus (HIV), with an optimal immune-virologic status (CD4 + lymphocytes 676 and 1013 cells/µl and undetectable HIV-RNA within 6 months before MPX diagnoses), and one was taking HIV preexposure prophylaxis (PrEP). All reported high-risk sexual behaviors, >10 partners in the 3 months before their MPX diagnosis, and had a past medical history of sexually transmitted infections (STIs). Real-time polymerase chain reaction (RT-PCR) (RealStar ® Orthopoxvirus PCR Kit 1.0; Altona Diagnostics) targeting the variola virus and the nonvariola Orthopoxvirus species (cowpox, MPX, raccoonpox, camelpox, vaccinia virus) was used to detect nonvariola DNA on swabs and serum, plasma, seminal fluids, and urine samples and a specific RT-PCR targeting MPX virus DNA (Liferiver; Shanghai ZJ Bio-Rech Co., Ltd) subsequently confirmed MPX infections. No concurrent STIs were detected in all cases. Individuals were hospitalized for severe MPX involvement at different sites: (Case 1) pharyngeal and laryngeal MPX associated with dyspnea, dysphonia, and dysphagia; (Case 2) cutaneous and genital MPX with >50 lesions and suspected bacterial superinfection; (Case 3) rectal MPX with >30 perianal and intrarectal lesions with uncontrolled severe pain; (Case 4) ocular MPX with >10

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A retrospective case-control study found that multicomponent meningococcal serogroup B vaccination was associated with lower risk of gonorrhea in men who have sex with men living with HIV.

ObjectivesTo explore different sexual behaviours as risk factors for STI among men who have sex with men (MSM) living with HIV.MethodsThis is a cross-sectional study on MSM living with HIV followed at the Infectious Diseases Unit of San Raffaele Hospital, Milan, with at least one diagnosis of gonorrhoea, syphilis, chlamydia or anal human papilloma virus (HPV), between July 2016 and February 2021. We conducted a survey on high-risk sexual behaviours with regard to (1) mean number of partners per month, (2) estimated percentage of condom use and (3) most frequent type of sexual intercourse during 2016–2021. Data on these variables were grouped as follows: (1a) ≤5 vs >5, (1b) >10 vs ≤10, (2a) 0% vs >0%, (2b) ≤50% vs >50%, (2c) 100% vs <100%, (3a) ≥50% vs <50% receptive, (3b) 100% vs <100% insertive, and (3c) 100% vs <100% receptive. A high-risk group was defined as >5 partners, <100% use of condom and ≥50% receptive intercourse. Univariate logistic regressions were applied to assess the association between sexual behaviours and the risk of each STI.ResultsOut of 1051 MSM with at least one STI diagnosis, 580 (55%) answered the survey. The risk of chlamydia was lower among individuals with ≤5 partners (≤5 partners vs >5 partners: OR=0.43, 95% CI 0.28 to 0.66, p=0.001) and among those using condoms more frequently (≤50% use of condom vs >50% use of condom: OR=1.55, 95% CI 1.06 to 2.27, p=0.025; 100% vs <100%: OR=0.35, 95% CI 0.20 to 0.59, p=0.001). Individuals using condoms more frequently also had lower risk of gonorrhoea (100% use of condom vs <100% use of condom: OR=0.37, 95% CI 0.17 to 0.79, p=0.011). The risks of chlamydia (OR=3.07, 95% CI 1.92 to 4.90, p<0.001) and gonorrhoea (OR=2.05, 95% CI 1.12 to 3.75, p=0.020) were higher among individuals belonging to the high-risk group.ConclusionsChlamydia and gonorrhoea are more likely associated with high-risk sexual behaviours than syphilis and anal HPV among MSM living with HIV.