(ORDO NEWS) — Until now, women, as well as transgender women and non-binary individuals assigned female at birth, have been extremely rare in monkeypox studies.
However, scientists are confident that the situation may change and new data will help in the fight against the global outbreak of this disease.
From May to November 2022, more than 78,000 cases of monkeypox infection were registered in the world. In most cases – from 96.2% to 100% – it was diagnosed in men who had sex with members of the same sex.
However, this infectious disease does not bypass women. How they develop monkeypox is the subject of a new study by an international team of clinicians led by Queen Mary University of London (UK). The results are published in The Lancet.
The authors of the report obtained information on 136 women – 69 cisgender, 62 transgender – and five non-binary persons with a confirmed diagnosis of monkeypox (between May 11 and October 4) from 15 countries, mostly European.
The median age was 34 years (28 to 40 years); 45% were Hispanic, 40% were White, 21% were Black, and 3% were Asian.
Over the past month, 121 women (89%) out of 136 told about sexual relations with men, two were pregnant. 59% of cis women and non-binary people had a regular male partner.
Doctors suggest that 55 trans women, as well as 45 cis women and non-binary people (74%) contracted the monkeypox virus through sexual contact.
In some other cases, it was about domestic or non-sexual close contacts, someone got infected from health workers. For 18 people, the mode of transmission was unknown.
Thirty-four trans women and two cis women reported that they worked in the sex industry. A total of 37 people had HIV (36 of them were on therapy), 14 were injecting drugs. And 17 were diagnosed with sexually transmitted infections, most often syphilis.
The median incubation period was seven days (range four to 11). The rash occurred in 124 patients, in 105 it was in the form of vesicles or pustules, and in 95 patients it was located in the anogenital region.
Lesions of the mucous membranes of the vagina, anus, oropharynx or eyes were noted in 65 (55%) of 119 people for whom there were sufficient data.
On average, each person had 10-11 skin manifestations of monkeypox. In people with suspected non-sexual transmission, lesions of the anogenital region or mucous membranes were less frequently observed.
Hospitalization was required in 17 (13%) patients, the most common causes were phlegmon – acute diffuse purulent inflammation of the cellular spaces – bacterial superinfection, abscess, severe anorectal pain and eye damage. No deaths have been registered.
The infection was treated mainly with the antiviral agent tecovirimat. Ten people were vaccinated against monkeypox before infection, six were vaccinated after contact with the diseased.
Monkeypox virus DNA was detected by polymerase chain reaction (PCR) in all 14 vaginal swabs tested.
Similarly, in previous studies involving men, the DNA of the virus was detected in semen samples. Therefore, the risk of sexual transmission – through bodily fluids – as well as through skin-to-skin contact is high.
Although 26% of cis women had children and lived with them, only two children also contracted monkeypox.
This is an encouraging and important discovery, since it is known that children can get sick more severely than adults, the scientists emphasized.
“This series of cases once again illustrates that monkeypox is a problem for all sexes and in all regions of the world.
Additional investment in surveillance, research and development is needed to understand the differences and similarities in clinical course and disease outcome across all affected regions, especially in Africa,” the authors of the report noted.
While monkeypox is indeed less common in women, the researchers warn that the proportion will increase as the epidemic progresses.
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