Monkeypox and Its Possible Sexual Transmission: Where Are We Now with Its Evidence?

Abstract

Monkeypox is a rare disease but is increasing in incidence in different countries since the first case was diagnosed in the UK by the United Kingdom (UK) Health Security Agency on 6 May 2022. As of 9 August, almost 32,000 cases have been identified in 89 countries. In endemic areas, the monkeypox virus (MPXV) is commonly transmitted through zoonosis, while in non-endemic regions, it is spread through human-to-human transmission. Symptoms can include flu-like symptoms, rash, or sores on the hands, feet, genitalia, or anus. In addition, people who did not take the smallpox vaccine were more likely to be infected than others. The exact pathogenesis and mechanisms are still unclear; however, most identified cases are reported in men who have sex with other men (MSM). According to the CDC, transmission can happen with any sexual or non-sexual contact with the infected person. However, a recent pooled meta-analysis reported that sexual contact is involved in more than 91% of cases. Moreover, it is the first time that semen analysis for many patients has shown positive monkeypox virus DNA. Therefore, in this review, we will describe transmission methods for MPXV while focusing mainly on potential sexual transmission and associated sexually transmitted infections. We will also highlight the preventive measures that can limit the spread of the diseases in this regard.

Symptomatology, prognosis, and clinical findings of Monkeypox infected patients during COVID‐19 era: A systematic‐review

“…Nonsexual contact includes direct contact with the rash, sores, or scabs of infected individuals, contact with objects or surfaces contaminated by infected individuals, or through respiratory droplets or oral fluids of infected individuals. 45,53 Spread of MPXV through sexual contact has received considerable attention after evidence from recent studies points towards a higher prevalence of MPXV infection in MSM. A study from the United Kingdom reported 54 MPX cases and noted that all the cases were MSM.…”

Possible adaption of the 2022 Monkeypox virus to the human host through gene duplication and loss

“…The MPXV of the 2022 outbreak may have become adapted to the human host, as continuous human-to-human transmission is seen for the first time since the discovery of MPXV in 1958. In addition, the mode of transmission and the phenotype of disease has changed [56,57]. Although adaption to the host is not necessarily correlated with increased pathogenicity and virulence, during the ongoing pandemic it is not known how the virus will evolve in future.…”

Monkeypox: epidemiology, pathogenesis, treatment and prevention

“…164 Another unusual feature is that the large number of cases diagnosed with monkeypox are male, and a considerable part of patients have sex with men (MSM), particularly in Canada, Spain, and the UK, suggesting that sexuality is another forms of close contact, even though monkeypox was not considered a sexually transmitted disease before. [165][166][167][168][169][170][171][172][173][174][175][176][177] It is reported that higher proportion of MSM infected is due to accidental entry into the community and then sexual behavior constituting "close contact" rather than sexual transmission of the monkeypox virus itself. 178 However, a study of samples from 528 confirmed cases outside endemic areas in Africa between April and June showed that 98% of patients were bisexual men or gay and 95% of those infected were suspected of transmission through sexual activity.…”