Sexually transmitted infections and clinical features in monkeypox (mpox) patients in Madrid, Spain

Maldonado-Barrueco, Alfredo; Sanz-González, Claudia; Gutiérrez-Arroyo, Almudena; Grandioso-Vas, David; Roces-Álvarez, Patricia; Sendagorta-Cudos, Elena; Falces‐Romero, Iker; Mingorance, Jesús; García-Rodríguez, Julio; Quiles-Melero, Inmaculada

doi:10.1016/j.tmaid.2023.102544

Cited by 17 publications

(17 citation statements)

References 15 publications

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“…A series of 33 patients with HIV (mostly well-controlled with CD4 counts >200 cells/mL) reported numerous coinfections with HSV1, HSV2, primary and secondary syphilis, and other sexually transmitted infections (STIs). 31 Compared to prior MPXV infections, Clade IIb (2022 strain) appears less virulent in a mouse model, with low mortality in immunocompetent individuals. 8 Patients with advanced HIV (CD4 count <350 cells/mL) have a higher risk of severe necrotizing and death, possibly related to treatment delays and/or immune reconstitution syndrome from starting HAART.…”

Section: Discussionmentioning

confidence: 96%

“…That population differs from the United States in having a later age of varicella primary infection and low vaccination rate, but this is less relevant for immunocompromised patients at risk for HSV/VZV at baseline. A series of 33 patients with HIV (mostly well‐controlled with CD4 counts >200 cells/mL) reported numerous coinfections with HSV1, HSV2, primary and secondary syphilis, and other sexually transmitted infections (STIs) 31 …”

Section: Discussionmentioning

confidence: 99%

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Mpox virus and coinfections: An approach to rapid diagnosis

et al. 2023

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We report a case of a 42-year-old immunocompromised (human immunodeficiency virus [HIV], CD4 count 86 cells/μL) Black male who presented with fever, oropharyngeal candidiasis, and phimosis, followed by eruption of umbilicated papulovesicles most concentrated on the face. The patient was diagnosed with Mpox (MPXV, formerly monkeypox), herpes simplex virus 1 (HSV1), varicella-zoster virus (VZV), and late latent syphilis. Tzanck smear of a Mpox lesion proved a useful and rapidly obtained pertinent negative test, lacking the typical changes of HSV/VZV (multinucleation, margination, and molding). A biopsy specimen showed viral changes consistent with both Mpox (ballooning degeneration and multinucleated keratinocytes) and herpesvirus (multinucleated epithelial giant cell within a zone of follicular necrosis).Lesion PCR was positive for HSV1 and MPXV, and negative for HSV2 and VZV.Immunohistochemistry was positive for VZV and orthopoxvirus. Empiric treatment for HSV/VZV in patients with suspected or confirmed Mpox should be considered for patients with HIV or other immunocompromised patients. It is important to recognize that MPXV, HSV, and VZV may all be present and difficult to distinguish clinically. More than one test modality (PCR, H&E, immunohistochemistry, and Tzanck) and multiple lesion samples may be required to thoroughly evaluate widespread papulovesicular eruptions, especially in immunocompromised patients.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Mpox virus and coinfections: An approach to rapid diagnosis

et al. 2023

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“…According to the WHO ( 16 ), the clinical differential diagnosis that must be considered includes other rash illnesses, such as chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies. A study conducted by Maldonado-Barrueco et al ( 17 ) highlighted the importance of considering other sexually transmitted infections (STIs) in the differential diagnosis of mpox, due to the differences in clinical management of the patient, treatment, and control of outbreaks of the different STIs.…”

Section: Discussionmentioning

confidence: 99%

Clinical Performance Evaluation of a Rapid Real-Time PCR Assay for Monkeypox Diagnosis: a Retrospective and Comparative Study

et al. 2023

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Given that a large number of mpox outbreaks have been reported worldwide since 2022 in countries in which the disease is not endemic, the main concern for clinicians and global health systems should be to develop effective, available, and easy-to-implement diagnostic strategies to interrupt mpox transmission as soon as possible. This retrospective study demonstrates the satisfactory clinical parameters of a commercially available molecular diagnostic kit for routine testing for mpox in clinical diagnostic laboratories.

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“…Testing for other bacterial sexually transmitted infections (STIs) at the time of mpox suspicion or diagnosis is also important. Cohorts from Germany, the USA, and Spain have shown that up to 50% of individuals with mpox were diagnosed with at least one other STI in the months preceding the infection including herpes, gonorrhea, chlamydia, syphilis, and Mycoplasma genitalium [ 20 ••, 23 , 50 ]. Concomitant STIs with mpox have been reported, with syphilis diagnosed in 16.4% of people with mpox and other bacterial STIs in 19% of cases [ 10 , 50 ].…”

Section: Introductionmentioning

confidence: 99%

“…Cohorts from Germany, the USA, and Spain have shown that up to 50% of individuals with mpox were diagnosed with at least one other STI in the months preceding the infection including herpes, gonorrhea, chlamydia, syphilis, and Mycoplasma genitalium [ 20 ••, 23 , 50 ]. Concomitant STIs with mpox have been reported, with syphilis diagnosed in 16.4% of people with mpox and other bacterial STIs in 19% of cases [ 10 , 50 ]. Furthermore, studies have shown a prevalence of anti-HCV antibodies in 6% of people with mpox [ 15 , 51 ] and 15.2% among PWH and mpox [ 51 ].…”

Section: Introductionmentioning

confidence: 99%

Mpox and HIV: a Narrative Review

et al. 2023

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Purpose of Review We reviewed the available literature on mpox in People with HIV (PWH). We highlight special considerations of mpox infection related to epidemiology, clinical presentation, diagnostic and treatment considerations, prevention, and public health messaging in PWH. Recent Findings During the 2022 mpox outbreak, PWH were disproportionally impacted worldwide. Recent reports suggest that the disease presentation, management, and prognosis of these patients, especially those with advanced HIV disease, can widely differ from those without HIV-associated immunodeficiency. Summary Mpox can often be mild and resolve on its own in PWH with controlled viremia and higher CD4 counts. However, it can be severe, with necrotic skin lesions and protracted healing; anogenital, rectal, and other mucosal lesions; and disseminated organ systems involvement. Higher rates of healthcare utilization are seen in PWH. Supportive, symptomatic care and single or combination mpox-directed antiviral drugs are commonly used in PWH with severe mpox disease. Data from randomized clinical control trials on the efficacy of therapeutic and preventive tools against mpox among PWH are needed to better guide clinical decisions.

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Sexually transmitted infections and clinical features in monkeypox (mpox) patients in Madrid, Spain

Cited by 17 publications

References 15 publications

Mpox virus and coinfections: An approach to rapid diagnosis

Mpox virus and coinfections: An approach to rapid diagnosis

Clinical Performance Evaluation of a Rapid Real-Time PCR Assay for Monkeypox Diagnosis: a Retrospective and Comparative Study

Mpox and HIV: a Narrative Review

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