Monkeypox, sexual spread confirmed

Monkeypox virus, seldom reported outside African until now,

Endemic in Africa

Cases now worldwide

METHODS

Formed an international collaborative group,

international case series, presentation, clinical course, outcomes of PCR confirmed infections

RESULTS

We report 528 infections diagnosed between

April 27 to June 24, 2022

Cases, 528, at 43 sites in 16 countries

98% in gay or bisexual men, 7

5% were White,

41% had HIV

median age 38

Transmission suspected to have occurred through sexual activity

95% of cases

Presentation in this series

95% rash

(with 64% having less than 10 lesions)

73% anogenital lesions

41% had mucosal lesions

(with 54 having a single genital lesion)

Common systemic features preceding the rash

fever (62%)

lethargy (41%)

myalgia (31%)

headache (27%)

lymphadenopathy (56%)

Concomitant sexually transmitted infections

109 of 377 (29%)

Among the 23 people with a clear exposure history

median incubation period, 7 days (range, 3 to 20)

Monkeypox virus DNA

Detected in 29 of the 32 (in whom seminal fluid was analyzed)

Management

Antiviral treatment given to 5% of cases

70 (13%) were hospitalized

Mostly for pain management

severe anorectal pain (21)

soft-tissue superinfection (18)

pharyngitis limiting oral intake (5)

eye lesions (2)

acute kidney injury (2)

myocarditis (2)

infection-control purposes (13)

No deaths were reported

CONCLUSIONS

Monkeypox manifested with a variety of dermatologic and systemic clinical findings.

Need for rapid identification and diagnosis of cases to contain further community spread.