(ORDO NEWS) — Among other things, a new report from Italian scientists has confirmed that during the current outbreak of monkeypox, men who have sex with men – often indiscriminately and unprotected – have become the main risk group.
The main route of transmission of the monkeypox virus to humans is from wild animals , such as primates and rodents.
But, as representatives of the World Health Organization have previously admitted, spread is also possible through sexual contact between people: this is indicated by the initial genital or perianal rash in those infected.
Now, Italian scientists from the Lazzaro Spallanzani National Institute for Infectious Diseases in Rome, the San Donato Hospital in Arezzo and the Umberto I Polyclinic in Rome have confirmed the presence of this pathogen in the seminal fluid of men.
The authors of the work talked about four patients diagnosed with monkeypox. All are young men from Italy, not older than 30 years old, who had homosexual relationships and one or more sexually transmitted diseases (STIs), in history: syphilis, hepatitis A, B or C.
At the same time, two (patients No. 1 and No. 3) had a confirmed HIV infection and received antiretroviral therapy. The rest (patients #2 and #4) received pre-exposure prophylaxis to reduce the risk of HIV infection.
All these men traveled to other countries in May 2022: three were in the Canary Islands and attended public events, and one, as scientists put it, traveled for the purpose of “sex business.” Abroad, they had sex without a condom with various male partners.
Patients were admitted in good clinical condition to medical facilities. Symptoms were generally as follows: fever, asthenia, deep-seated and well-circumscribed masses – including pruritic papules with a serous secretion – on the genitals, in the perianal region, single lesions were present on the chest, back, head, arms, legs and soles of the feet.
In all men, the manifestations of infection on the skin progressed asynchronously. One of them had been vaccinated against smallpox as a child.
“Specimens obtained from skin, genital and anal lesions, serum and plasma, seminal fluid, feces and nasopharynx were all positive for monkeypox virus DNA.
During the observation period, the patients had no systemic symptoms and recovered spontaneously without specific antiviral therapy. Anti-inflammatory and antihistamines were used to treat perianal pain and pruritus only in patient #2,” write the authors of the report.
Phylogenetic analysis showed that the studied variant of the monkeypox virus belongs to the West African lineage (in comparison with the Central African clade, this is a less virulent pathogen, it is the one that is spreading around the world today).
According to experts, the described four cases are generally consistent with the clinical picture observed during today’s outbreak of monkeypox in other patients. Recall that last week WHO registered 505 new cases in non-endemic countries (that is, this infectious disease is not typical for them).
“Characteristics of the cases and reports of multiple sexual intercourse without a condom suggest that person-to-person transmission, through close physical contact, plays a key role in the current outbreak.
This path was ineffective in previous outbreaks caused by the West African clade, ”the scientists emphasized. Secondly, their work is also important because the symptoms of these four men differ from those found in the scientific literature: skin lesions are now asynchronous – from single spots or whole “clusters”, raised papules with progressive ulceration to scabs. The lesions were predominantly located in the genital and perianal regions.
Finally, although monkeypox in endemic regions has always affected men more often, this was previously explained by the fact that they were more on the hunt. In today’s outbreak, meanwhile, most of those affected are men who have sex with men, often indiscriminately and unprotected.
In patients whose medical history is described in the new study, the lesions began to spread primarily from the genitals and perianal area – according to experts, this suggests that close contact during sexual intercourse was important for the transmission of the virus.
However, in order to draw unambiguous conclusions and classify monkeypox as an STI, further studies will be required to assess the presence, persistence and contagiousness of this virus in various body fluids and its ability to be transmitted sexually.
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