Health Security Agency (UKHSA) has reported the most detailed information about monkeypox among gay and bi men in the current outbreak. Six had genital ulcers, and five had anal ulcers. Most reported recent sex with multiple partners, and several had visited saunas. All were men, most in their twenties or thirties. All recovered without treatment.Īnother report in the same issue described 96 monkeypox cases in Portugal, with more detailed information on a subset of 27 cases. Three had very low levels of monkeypox virus DNA in their semen. All reported lesions on different parts of the body, including the genitals in three cases and the anal region in two cases. Three attended the Canary Islands event, and one said he traveled for sex work all reported condomless sex with different male partners while traveling. In Europe, a recent report in Eurosurveillance described four monkeypox cases among gay men in Italy, two of whom were HIV positive and on antiretroviral therapy and two of whom were HIV negative and on PrEP.
The CDC has not yet issued monkeypox guidance for people living with or at risk for HIV. In the United States, Demetre Daskalakis, director of the CDC’s Division of HIV/AIDS Prevention, declined to say whether any people diagnosed with monkeypox are HIV positive, citing patient confidentiality concerns. However, the organization suggests that people with a CD4 count below 200, persistent detectable viral load or a recent HIV-related illness should be considered at higher risk. “Currently, we do not recommend any specific actions for people with HIV beyond vigilance about clinical presentations and history of exposure,” the British HIV Association said in a rapid statement. “Those people living with HIV who are not on treatment or remain immunosuppressed may have a more severe course, as documented in the literature.” “There is limited data among people living with HIV, but those who take antiretrovirals and have a robust immune system have not reported a more severe course,” according to the WHO. Previous studies in Africa found that people with uncontrolled HIV had worse outcomes, including larger and longer-lasting lesions, more complications and several deaths, but those with well-controlled HIV appear to fare better. There is a dearth of data on monkeypox among people with HIV. Vaccines and antiviral medications used to prevent and treat smallpox are also effective for monkeypox. Severe outcomes are more common among children, pregnant people and immunocompromised people. But the sores can leave scars, and people with more severe disease may develop complications. Most people with monkeypox recover without treatment, and so far there have been no confirmed deaths in the current outbreak. Monkeypox lesions UK Healthy Security Agency
Monkeypox has an incubation period of up to three weeks before symptoms start, and the illness usually lasts two to four weeks. The lesions may resemble chickenpox or common sexually transmitted infections (STIs), such as herpes or syphilis. In the current outbreak, many men have presented with lesions on the genitals or in the anal area. Monkeypox, which is related to smallpox but less severe, typically causes flu-like symptoms, swollen lymph nodes and a rash that can appear on the face, in the mouth or elsewhere on the body. Many of them reported recent international travel, and many visited saunas or attended large events, including a Pride festival in the Canary Islands. While anyone can contract monkeypox through close personal contact, most people affected by the outbreak in non-endemic countries are gay, bisexual and other men who have sex with men. It is not known whether monkeypox is sexually transmitted in semen or vaginal fluid, but it can spread via contact with sores during sex. It also can be transmitted through respiratory droplets at close range, but it does not spread over longer distances like the coronavirus that causes COVID-19. This can include skin-to-skin contact, kissing and contact with contaminated clothing or bed linens.
The monkeypox virus is transmitted from animals and from person to person through close contact. The United Kingdom, Spain, Portugal, Germany and Canada have reported the most cases outside Africa. Worldwide, the World Health Organization (WHO) has confirmed 1,285 cases in more than two dozen countries where the virus is not endemic as of June 10.
In the United States, the Centers for Disease Control and Prevention (CDC) has reported 72 confirmed cases of monkeypox in 17 states and Washington, DC, as of June 14, including 15 cases each in California and New York. So far, it appears that people on antiretroviral treatment with well-controlled HIV do not have worse outcomes. As monkeypox continues to spread in Europe and North America, mostly among gay and bisexual men, much remains to be learned about its impact on people living with or at risk for HIV.