Monkeypox cases that could have been missed

Despite the disappearance of monkeypox from public attention, scientists are still learning how it spreads, including without sexual contact or any symptoms .

During the monkeypox epidemic that unfolded this summer in the United States and dozens of other countries, men who had sex with men were most at risk. But thousands of women were also infected, and many more were likely missed, according to the first-ever study of women and non-binary people who had contracted the disease.

As in men, sexual contact was the most likely source of infection in transgender women, accounting for 89% of cases, according to the case series published Thursday in the journal Lancet. But among cisgender women and non-binary people who were designated female at birth, only 61% of cases could be linked to sexual contact.

About a quarter of cisgender women in the study could have been infected without sexual interaction with an infected person, said Dr Chloe Orkin, a physician and researcher at Queen Mary University of London. The women are thought to have been infected through exposure at work or home or through other types of close contact.

"The lesson here is that everyone world needs to know about this," said Dr. Orkin. While it is appropriate that public health messaging is directed primarily at men who have sex with men, she added, "it is important to recognize that this is not the only group".

After several months of rapidly increasing case numbers, the monkeypox outbreak in the United States has slowed, thanks in part to a vaccination campaign and behavioral changes by many high-risk people.Since May, there have been just over 29,000 cases in the United States, but only about a thousand cases have been diagnosed over the past month.

Yet as the disease fades from public attention, scientists are just beginning to understand when and how it spreads and who is at risk.

In the new study, Dr. Orkin and his colleagues discovered genetic material from monkeypox virus in the 14 vaginal swabs they tested, suggesting that the virus can be transmitted through genital secretions. Studies in men have also found the virus in seminal fluid.

Yet public health authorities have been reluctant to call monkeypox a sexually transmitted infection, arguing that the virus can be spread in close proximity physical contact of any kind.

But some experts disagree: that monkeypox can be transmitted in other ways should not preclude its classification as a sexually transmitted disease, as other diseases like herpes and syphilis can also be spread through close non-sexual contact, some say.

Last month, New York State added monkeypox to its list of sexually transmitted infections, but the Centers for Disease Control and Prevention did not make the change. The agency will leave that categorization to individual states, said Dr. Demetre Daskalakis, deputy White House monkeypox response coordinator. But it's clear that sexual behavior is driving the cases, he said.

"If you removed sex, would we have had an outbreak of monkeypox? Probably not,” he added. Even though the main reason for the spread is skin-to-skin contact during sexual activity, “it is definitely sexually associated transmission.”

< figure class="img-sz-medium css-d754w4 e1g7ppur0" aria-label="media" role="group">ImageMorgan Verrett, a Renegade Bio Lab Assistant, pr...