Following the finding that monkeypox virus particles can be present in the semen of infected individuals, the World Health Organisation (WHO) is now exploring the possibility that the virus could be sexually transmissible.
The case study by researchers from the Spallanzani Institute, Italy, a Rome-based hospital and infectious disease research facility, was published in Eurosurveillance. It includes data from four male patients that recently had sex with men. Out of the four patients, three tested positive for monkeypox in seminal fluid during the study period. For the fourth patient this data was not available.
While this data alone is not enough evidence to prove that the mode of transmission of monkeypox has changed, 'having an infectious virus in semen is a factor that tips the balance strongly in favour of the hypothesis that sexual transmission is one of the ways in which this virus is transmitted', said the general director of the Spallanzani Institute, Francesco Vaia.
Since the publication the authors found six out of seven patients at the facility to have semen containing monkeypox genetic material. Researchers in Germany have since also reported the virus in semen samples of their patients in a yet to be peer-reviewed publication.
Dr Hugh Adler from the Liverpool School of Tropical Medicine, who was not involved in either study, cautioned further research needs to be undertaken to confirm the hypothesis of sexual transmission: 'We already knew that monkeypox virus can be found in blood and urine – therefore it had the potential to be detected in genital secretions... The presence of viable infectious virus, if confirmed and replicated in further patients, would be more supportive of the virus genuinely being present in semen.'
The name monkeypox is misleading. The virus was initially discovered in 1958 in monkeys kept for scientific research, but its natural hosts are likely rodents. In 1970 it was first found in humans in the Democratic Republic of Congo. Typical symptoms of a monkeypox infection are fever, headaches, and lymph node swelling as well as the occurrence of pus-filled infectious blisters – the pox lesions. A close relative to monkeypox, smallpox, was eradicated in the 1970s through a global vaccination campaign using a related virus called vaccinia virus. Due to the similarity of these viruses, people vaccinated against smallpox are likely, at least partially, to be protected against monkeypox.
As many of the infected individuals are members of the LGBTQI+ community, the WHO is now reaching out to organisers of Pride events to raise awareness. The WHO's general director for Europe Dr Hans Kluge also cautioned against stigmatising specific populations, as was the case in the 1980s during the AIDS crisis: 'We must remember that the monkeypox virus is not in itself attached to any specific group.'
Sources and References
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Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022
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Monkeypox DNA found in semen in handful of cases - researchers say
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WHO investigates reports of monkeypox virus in semen
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Monkeypox outbreak questions intensify as cases soar
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WHO investigating claims that monkeypox found in semen
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