Should monkeypox be considered a sexual transmitted infection?

The monkeypox virus, which is a zoonotic DNA virus belonging to the family Poxviridae, was first identified in the Asian Macaca fascicularis monkeys in Copenhagen, Denmark in 1958. This virus was first found to infect humans in 1970 when it was isolated from a nine-month-old boy in the Democratic Republic of the Congo after the smallpox vaccination regulations had been withdrawn from the region.

Study: Monkeypox: Another Sexually Transmitted Infection? Image Credit: Dotted Yeti / Shutterstock.com

Study: Monkeypox: Another Sexually Transmitted Infection? Image Credit: Dotted Yeti / Shutterstock.com

Background

Previously, the monkeypox virus was endemic in West and Central African countries. The monkeypox virus can be further subdivided into two clades, with the central African (Congo Basin) clade often considered the more pathogenic clade that is associated with more severe disease.

In 2003, the first monkeypox outbreak was identified outside of Africa during a spillover event from wild rodents exported for pet use to the United States. During this animal-to-human transmission event, children from six American states were infected.

Since 2018, several monkeypox virus outbreaks have been reported in the United Kingdom (UK), Singapore, and the U.S. More recently, several other outbreaks have been reported in the U.K., as well as other European and non-European countries. In fact, as of June 28, 2022, over 2,600 human monkeypox virus infections have been confirmed worldwide.

The current monkeypox outbreak

The present monkeypox outbreak is marked by sustainable human-to-human transmission, even among people who have not recently traveled to nations where the virus is endemic. Furthermore, many of these cases have been reported among men who have sex with men (MSM), which has raised concerns about the possible sexual transmission of the monkeypox virus. 

Some of the monkeypox cases identified during the current outbreak have been reported among individuals infected with the human immunodeficiency virus (HIV), specifically in MSM populations. Moreover, the monkeypox virus was detected in the seminal fluid, as well as genital and rectal lesions, of four MSM patients with monkeypox infection from Italy. 

Recent clinical evidence supports the probability that sexual transmission of the monkeypox virus has occurred during the current outbreak. Although further studies are needed to confirm global speculations, definitive evidence of infectivity is lacking. Nevertheless, viral shedding and its efficiency for sexual transmission have been confirmed. 

The risk of monkeypox transmission through sexual contact emphasizes the need to increase awareness among the sexually active population to prevent future outbreaks. According to the European Centers for Disease Control (ECDC), vulnerable populations include those with multiple sexual partners, particularly those within the MSM and lesbian, gay, bisexual, transgender, and intersex (LGBTI) community.

Is monkeypox a sexually transmitted infection?

Monkeypox infection was initially considered only zoonotic; however, the interhuman transmission of this virus through direct contact with lesions, respiratory droplets, body fluids, and contaminated materials has been reported for several years.

The likelihood that the monkeypox virus can be transmitted sexually would confer important inclusions during the evaluation of patients with HIV, as well as those with other sexually transmitted infections (STIs) who present with fever and lymphadenopathy followed by a vesicular-papular rash.

These considerations should also be extended to the assessment of patients with genital ulcers, particularly those who have recently traveled to locations with confirmed monkeypox cases. Notably, genital ulcers have been reported in 52 cases during the most recent monkeypox outbreak. 

Preliminary data indicate that the factors that increase an individual’s susceptibility to HIV infection can also increase their risk of being infected with the monkeypox virus. These risk factors include being a young male who has sex with other men, engages in risky behaviors and activities including unprotected (barrier-free) sex, is HIV positive, and has a history of previous STIs, like syphilis.

Prevention

Some of the approaches that can assist in preventing monkeypox transmission include the implementation of zoonotic disease programs, including interaction and integrated strategies with awareness regarding sexual health and education towards STIs. Furthermore, the active involvement of various national and international scientific associations may also assist in mitigating the current monkeypox outbreak and limit its ability to become another pandemic. Taken together, these efforts would also reduce the global public health burden imposed by STIs.

Journal reference:
Nidhi Saha

Written by

Nidhi Saha

I am a medical content writer and editor. My interests lie in public health awareness and medical communication. I have worked as a clinical dentist and as a consultant research writer in an Indian medical publishing house. It is my constant endeavor is to update knowledge on newer treatment modalities relating to various medical fields. I have also aided in proofreading and publication of manuscripts in accredited medical journals. I like to sketch, read and listen to music in my leisure time.

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