Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.
Department of Dermatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.
J Eur Acad Dermatol Venereol. 2023 Sep;37(9):1891-1896. doi: 10.1111/jdv.19223. Epub 2023 May 27.
In May 2022, an outbreak of mpox (monkeypox) in men-who-have-sex-with-men (MSM) emerged and quickly affected over 100 countries. In the early stages of the outbreak, overlap in symptoms with sexually transmitted infections (STI) made triage for mpox testing challenging. More information was needed on whom to screen and the main route of transmission.
We aimed to identify characteristics of mpox cases to further strengthen case definitions. We also compared Cycle threshold (Ct) values of the DNA positive mpox samples as a proxy for viral load by body location.
From 20 May 2022 to 15 September 2022, we tested all MSM who presented with malaise, and/or ulcerative lesions, and/or proctitis and/or a papular-vesicular-pustular eruption attending the Centre of Sexual Health in Amsterdam, the Netherlands, for mpox, with a PCR test. In the same period, 6932 MSM mpox unsuspected clients were not tested. We compared those tested positive for mpox with those tested negative and those unsuspected for mpox.
Of the 374 MSM tested, 135 (36%) were positive for mpox. The mpox-positive MSM were older (median age, respectively, 36, 34 and 34 years, p = 0.019) and more often lived with HIV (30% vs. 16% and 7%, p < 0.001). Furthermore, mpox-positive patients more often reported receptive anal sex without a condom, sexualized drug use, more sex partners, and were more often diagnosed with bacterial STI (p < 0.001). Systemic symptoms and anogenital lesions were associated with mpox infection. For mpox-positive patients, anal samples (p = 0.009) and lesional samples (p = 0.006) showed significantly lower median mpox Ct values compared to throat samples.
Mpox-positive patients more often reported receptive anal sex without a condom, had more sex partners and more often lived with HIV. Our results suggest that in the current mpox outbreak among MSM, sexual transmission is the main route.
2022 年 5 月，男男性行为者（MSM）中爆发了猴痘（猴痘）疫情，迅速蔓延至 100 多个国家。在疫情早期，与性传播感染（STI）症状重叠，使得猴痘检测的分诊具有挑战性。需要更多关于筛查对象和主要传播途径的信息。
我们旨在确定猴痘病例的特征，以进一步加强病例定义。我们还比较了按身体部位划分的 DNA 阳性猴痘样本的循环阈值（Ct）值作为病毒载量的替代指标。
从 2022 年 5 月 20 日至 2022 年 9 月 15 日，我们对所有出现不适、溃疡性病变、直肠炎和/或丘疹-水疱-脓疱疹的 MSM 进行了检测，这些 MSM 就诊于荷兰阿姆斯特丹性健康中心，采用 PCR 检测进行猴痘检测。在同一时期，有 6932 名 MSM 未接受过猴痘检测。我们比较了检测阳性的 MSM 与检测阴性的 MSM 和未怀疑有猴痘的 MSM。
在 374 名 MSM 中，135 名（36%）猴痘检测阳性。与检测阴性和未怀疑有猴痘的 MSM 相比，猴痘阳性 MSM 年龄更大（中位数年龄分别为 36、34 和 34 岁，p=0.019），且更常患有 HIV（30%比 16%和 7%，p<0.001）。此外，猴痘阳性患者更常报告无保护的肛门性行为、性使用毒品、性伴侣更多，且更常被诊断为细菌性 STI（p<0.001）。全身症状和生殖器病变与猴痘感染有关。对于猴痘阳性患者，肛门样本（p=0.009）和病变样本（p=0.006）的猴痘 Ct 值中位数明显低于咽喉样本。
猴痘阳性患者更常报告无保护的肛门性行为、性伴侣更多，且更常患有 HIV。我们的结果表明，在当前 MSM 中猴痘爆发期间，性传播是主要传播途径。
