1. Clinical evidence, high viral loads, and participant history suggests close contact as the main transmission method of monkeypox in this current outbreak.

2. Complications of monkeypox include proctitis and tonsillitis in those that engage in anal-receptive and oral-receptive sex, respectively.

Evidence Rating Level: 2 (Good)

Study Rundown: Monkeypox has recently been declared a public health emergency by the World Health Organization (WHO). This study aimed to characterize the clinical presentation and virological assessment of confirmed monkeypox cases in Spain. Individuals with laboratory-confirmed monkeypox were enrolled. Participants were mostly (92%) men who identified as gay, bisexual, or other men who have sex with men (MSM). All participants presented with skin lesions, including genital, perianal and oral lesions. A large percentage of participants reported systemic symptoms, such as a flu-like illness. Complications included proctitis with most cases having reported prior anal-receptive sex and tonsilitis with most cases having reported prior oral-receptive sex. Interestingly, smallpox vaccination was reported in 18% of participants, which may warrant further investigation into the efficacy of the vaccine against monkeypox infection. Limitations to this study include the inability to report an accurate incubation period due to multiple exposure events being reported by participants. Nevertheless, this study adds to current evidence for a method of transmission and clinical presentation of monkeypox during the current outbreak.

Click to read the study in The Lancet

Relevant Reading: Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis

In-Depth [prospective cohort study]: This multicentre prospective cohort study enrolled participants from three hospitals in Spain. Eligibility criteria included confirmed monkeypox infection by laboratory assay of a skin lesion, anal or oropharynx swab. Participants were interviewed by either a dermatologist or specialist in sexually transmitted infections. Outcomes included a report of qualitative characteristics of the participants as well as clinical outcomes 14 days after initial presentation. A total of 181 patients were included in the study, 175 (97%) were male and the average age was 37.0 years. 166 (92%) participants identified as gay men, bisexual men and other men who have sex with men (MSM). 72 (40%) of participants were HIV-positive of which 71 (99%) were on antiretroviral therapy. 32 (18%) individuals reported history of a smallpox vaccine. All participants presented with skin lesions and 99% of the swabs of skin lesions tested positive. Common locations for skin lesions included anogenital (78%), hands and feet (60%), trunk and extremities (57%), and oral and perioral regions (43%).

Three patients required hospitalization and there were no reported deaths. 160 (88%) participants reported systemic symptoms, such as an influenza-like illness. Complications that were seen included proctitis (25%), tonsillitis (10%), and penile oedema (8%). MSM who engaged in anal-receptive sex presented more frequently with proctitis (absolute difference 31% [95% CI 19-44]; p<0.0001) and systemic symptoms prior to developing a rash (absolute difference 34% [28-62]; p<0.0001) compared to MSM who did not report anal-receptive sex. Tonsillitis was reported in 19 participants, of which 18 (95%) reported engaging in oral-receptive sex.

Image: PD

©2022 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.