A new study of GeoSentinel Network data involving 226 monkeypox cases from 15 countries shows that, of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset.

The study is published in The Lancet Infectious Diseases and adds to a growing body of literature that shows the monkeypox outbreak is primarily fueled by sexual contact.

Other important findings show that men who have sex with men (99% of all male patients) reported a median of three recent sexual partners, and clinical manifestations of the virus differed by HIV status, but HIV status did not correlate with more severe disease outcomes.

Monkeypox patients who were HIV-positive were more likely to report diarrhea, anal rash and lesions, and a higher rash burden.

Data were collected from May 1 to Jul 1, 2022, across 71 clinical sites in 29 countries. The median age of patients was 37 years, and 44% were HIV-positive. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control, the authors said.

Mass gatherings linked to transmission

A significant proportion of patients reported attending large mass gatherings before developing monkeypox symptoms. Of 161 patients with available information, 37 (23%) met their sexual partners at such gatherings, including the Maspalomas Festival on Spain's Gran Canaria island, and various other Pride-related festivities in Europe and the United States, the authors said.

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