Epidemiologic and clinical features of monkeypox virus infection in cisgender and transwomen and nonbinary individuals

Epidemiologic and clinical features of monkeypox virus infection in cisgender and transwomen and nonbinary individuals

A recently published study in The lancet described the clinical and epidemiological features of monkeypox virus (MPXV) infection in cisgender (cis) and transgender (trans) women and non-binary individuals.

Lernen: Infektion mit dem menschlichen Affenpockenvirus bei Frauen und nicht-binären Personen während der Ausbrüche im Jahr 2022: eine globale Fallserie. Bildnachweis: Dotted Yeti/Shutterstock

background

From May to November 2022, more than 78,000 MPXV infections were reported in over 100 countries where MPXV infections have not been documented in the past, with the monkeypox (MPX) outbreak classified as a public health emergency of international concern by the World Health Organization (WHO). in July 2022. Sexually active gay, bisexual and other men who have sex with men (GBMSM) have been almost exclusively affected by MPXV in the ongoing outbreak.

About 28% to 47% of people diagnosed with MPX are living with human immunodeficiency virus (HIV). The sustained spread of MPX has not yet occurred outside of GBMSM networks; However, the spread of MPXV to women is a significant problem, primarily due to the potentially serious consequences for fetuses if pregnant individuals become infected with MPXV.

Epidemiological surveillance datasets have not differentiated between cisgender and trans women. It has been reported that of over 25,000 cases of MPX in the United States, 3.8% occurred in cisgender women and 0.8% occurred in trans women. The number of MPXV infections in women is likely unknown and likely underestimated given international case definitions that specify GBMSM as a risk group.

About studying

In the present study, researchers described the clinical and epidemiological features of MPXV infection in a cohort of women and non-binary individuals from 15 countries. Participating clinicians identified nonbinary individuals and women with MPXV infection and asked them to participate.

Confirmed MPX was defined as a positive MPXV-specific polymerase chain reaction (PCR) test in samples collected from any anatomical site. Contributing centers were provided with structured, deidentified case report spreadsheets developed by participating clinicians and adapted to include variables relevant to women and non-Naryans.

The spreadsheets used free-text fields and drop-down menus to allow physicians to capture data from paper or electronic medical records. The tables focused primarily on demographic characteristics, occupation, potential exposures, clinical findings, HIV status, early symptoms, diagnosis, concurrent sexually transmitted infections (STIs), complications, and HIV status.

Results

The present case series included 136 women and non-binary individuals from 15 countries and three WHO regions who presented from May 11 to October 4, 2022. Of these, 68 came from the European region, 65 from the Americas region and three came from the African region. The median age was 34 years, with most individuals being Latinx (45%), followed by white (29%) and black (21%).

Sixty-nine people were cisgender women, 62 were trans women, and five were non-binary people assigned female gender at birth. Overall, 89% of participants reported having sexual activity with men in the past month. Thirty-four trans women, two cisgender women, and non-binary individuals reported active/current sex work.

Nineteen people had children, including one non-binary person; two children subsequently developed MPXV. 37 people had HIV, mostly trans women. Of these, 36 received antiretroviral therapy. Trans women have had more sexual partners than others in the last three months.

In 100 MPX cases, sexual contact was suspected to be the most likely route of transmission. Suspected non-sexual transmission routes included occupational exposure, household contacts, and close non-sexual contacts. Seventeen people had a concurrent STI. Forty-one trans women presented to HIV or sexual health clinics and 13 to emergency departments. Non-binary people and cisgender women often present to emergency rooms and HIV/sexual health clinics.

The median incubation period was seven days based on assumed exposure and symptom onset dates available for 51 participants. Seventy-six individuals with systemic features. Skin lesions were observed in 124 people. At least one anogenital lesion was present in 95 individuals.

Mucosal lesions of the eye, anus, vagina, or oropharynx occurred in 65 participants. Vulval lesions were present in 42 cisgender women and non-binary individuals assigned female gender at birth. Perianal skin lesions were observed in 45 trans women and 17 cisgender women, as well as in non-binary individuals.

Vaginal sex was reported by 35 of 46 subjects with vaginal lesions and anal sex by 49 subjects with anal lesions. In total, 34 participants lacked anogenital lesions. The mean number of lesions (10) was similar in cisgender and trans women. All skin and vaginal swabs were positive for MPXV, while 73% of nasopharyngeal swabs were positive.

Seventeen participants were hospitalized for cellulitis, bacterial superinfection, severe anorectal pain, abscesses, odynophagia, ocular lesions, infection control purposes, or altered mental balance. MPXV infection was treated with tecovirimat. Tecovirimat treatment was more common in patients with HIV infection than in those without. Six participants received post-exposure vaccination and 11 received pre-exposure vaccination.

Conclusions

In conclusion, the current case series provided insights into the clinical features and epidemiology of MPX in cisgender women, trans women, and non-binary individuals. The authors found that the distinctive mucosal and genital features commonly observed in men during the ongoing outbreak were replicated in cis/trans women and non-binary individuals.

Anogenital lesions reflected sexual practices; That is, most participants who reported vaginal and anal sex had lesions near these anatomical sites. Together, these results will aid clinicians in MPX diagnosis in cis/trans women and non-binary individuals and underscore the importance of sexual history and testing for STIs.

Reference:

• Thornhill, J. et al. (2022) „Menschliche Affenpockenvirusinfektion bei Frauen und nicht-binären Personen während der Ausbrüche von 2022: eine globale Fallserie“, The Lancet. doi: 10.1016/s0140-6736(22)02187-0. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02187-0/fulltext

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