Study describes monkeypox cases in cisgender and transgender women

Most current monkeypox cases are homosexual men, but some women are also susceptible. New research published today lancet describes 136 cases of cisgender and transgender women and nonbinary individuals from 15 countries.

Although the epidemiology, clinical manifestations, and case outcomes of men, cis women, and trans women are similar in many respects, this study revealed some striking differences. Monkeypox spread rapidly among sexually active homosexual men this summer, but the cisgender women in the case series had far fewer sex partners, and the cases could lead to subsequent infections. Low. So far there is no sustained spread outside the network of men who have sex with men.

Nonetheless, monkeypox can cause complications during pregnancy, so caution should be exercised in female cases. It highlights the socially unstable position of

“During the global pandemic, case definitions have rightly focused on the most affected group: sexually active men who have sex with men. It is tailored to reach,” said Professor Chloe Orkin of Queen Mary University of London, who is spearheading an international collaboration of clinicians studying monkeypox. “But as the outbreak progresses, it is important to also look at underrepresented groups, such as women and nonbinary individuals, to better understand the risks … These learnings will help to include these groups. help inform and coordinate effective public health measures to

As Previously reported AIDS mapsthe United Kingdom Health Security Agency (UKHSA) reported the first monkeypox case in the current outbreak in early May. Over 3700 confirmed or probable cases in England. As of November 16, the World Health Organization (WHO) is counting. Over 80,000 cases worldwidemostly in countries where monkeypox had not been reported historically, and killed 51 people.

In the cases with available data, approximately 97% are men, 86% identify as having sex with men, and about half with known status are men. living with HIVThis contrasts with the historical pattern in Central and West Africa, where one-third to one-half of monkeypox cases are women, and cases in children are not uncommon.

Monkeypox incidence has fallen dramatically from its peak in July, with new cases in the UK dropping to single digits in recent weeks. However, many experts believe the virus will never be eradicated and may continue to spread at low levels, especially among disadvantaged communities.

Orkin and a large team of collaborators in the SHARE-net international clinical network the aforementioned More than 500 monkeypox cases diagnosed in the first months of the outbreak were predominantly gay men.

Collaborators are currently studying 69 cisgender women diagnosed with monkeypox between May 11 and October 4, 2022, 62 transgender women, and 5 women assigned female at birth. published a new case series describing a non-binary individual with Her median age was 34, slightly younger than the median of 39 in a previous analysis of gay men. Most were Latinas (45%), whites (29%), or blacks (21%). About half lived in Europe and half in the Americas. Only three were in Africa.

monkeypox infection

Sexual contact was a suspected route of transmission in nearly all men in previous case series, but this was reduced to 74% in the new analysis. Among cisgender women and nonbinary people, 61% of her are believed to have contracted monkeypox through sexual activity, whereas for trans women this rose to 89% of her. 15% and 11%, respectively, had an unknown route of infection.

All trans women and 14% of cis women and non-binary people reported anal sex, while 69% of cis women and 1 trans woman did not report vaginal sex (of trans women , vaginoplasty, or gender-affirming “bottom” surgery). The trans woman had a median of 10 sex her partners in the last 3 months, and 73% reported multiple male partners. Cis women, on the other hand, were much more likely than trans women to report that the median girlfriend had one girlfriend and regular partners had one girlfriend (61% vs. 13%, respectively). .

More than half of trans women (55%) reported sex work, compared to just 3% of cis women and nonbinary people. Among those tested, 21% of trans women and 7% of cis women had concurrent sexually transmitted infections (STIs). 1 in 10 reported injecting drug use (11% of trans women, 9% of cis women). Eight (6%) had experienced homelessness and four (3%) were immigrants.

Only cisgender women suspected non-sexual transmission routes, including domestic contact (10%), non-sexual close contact (10%), and occupational exposure of health care workers (5%) . The case series involves two nurses who supposedly contracted the virus while caring for a monkeypox patient. One accidentally injured a scalpel while collecting lesion samples, and another of hers was unable to use PPE when handling monkeypox virus samples. Encouragingly, about a quarter of cis women had children in the same household, but she was the only two who contracted monkeypox, “a very limited chain of transmission.” suggests that, write the study authors.

Just over a quarter (27%) of confirmed infected women are living with HIV, slightly lower than the 41% rate seen in previous analyzes of mostly gay men. I’m here. But again, the overall proportions hide a large disparity between trans women (50% HIV positive) and cis women and nonbinary people (8% positive). Nearly all HIV-infected individuals were receiving antiretroviral therapy, 81% had an undetectable viral load, and had a median CD4 count of 600. Exposure prophylaxis (PrEP).

“The inclusion of transgender women and nonbinary individuals in this series demonstrates the importance of demographic and outcome data disaggregated by both sex and gender,” said co-authors. said Dr Asa Radix of the Karen Road Community Health Center in New York City. .

However, this kind of analysis has not yet been performed on transgender men, some of whom are part of gay male sexual networks and are at risk for monkeypox. U.S. Centers for Disease Control and Prevention report About 70 cases of trans men.

symptoms and care

Like the gay men in previous case series, the majority of trans women with suspected monkeypox visited sexual health or HIV clinics. In contrast, cisgender women presented to emergency departments, sexual health or HIV clinics, hospital dermatology departments, obstetrics/gynecology departments, or primary care providers. “This reinforces the need for education of health professionals beyond sexual health clinics to ensure monkeypox symptoms are not misdiagnosed and limit further transmission,” said the study’s authors. says.

In general, women in this case series reported symptoms similar to men in previous analyses. Nearly all (93%) developed skin rashes or lesions, with a median of 10 sores on her part. Cis and trans women and those with sexual and non-sexual routes of transmission had similar numbers of lesions: just over 60% had systemic symptoms such as fever and fatigue. As seen in previous analyzes of men, compared with cis women, trans women were more likely to develop localized infections without systemic symptoms.

About three-quarters (74%) had at least one anal or genital lesion, and about one-quarter had an oral lesion. The majority of cisgender women and nonbinary people had lesions in the vulva (external genitalia) or vagina. or had rectal lesions or proctitis (inflammation of the rectum). These symptoms often mimic other sexually transmitted diseases and were initially misdiagnosed in 34% of cis women and 10% of trans women.

“As the outbreak progresses, it is important to also pay attention to underrepresented groups such as women and nonbinary individuals.”

“[T]The location of the lesions was largely consistent with the type of sexual activity reported,” said the study authors. “Clinicians must recognize different clinical manifestations depending on gender identity and sexual activity.” Those with suspected non-sexually transmitted infections were much less likely to develop anal and genital lesions. However, some people developed the disease.

Monkeypox DNA was detected in all 14 women with vaginal swabs, as was the case in 29 of 32 men with semen samples collected in previous analyses. Additionally, approximately three-quarters of anal/rectal swabs, buccal swabs, and blood samples were positive. According to the authors, “This increases the chances of sexual transmission via bodily fluids and skin-to-skin contact.” Other studies suggest Monkeypox can be contagious even without symptoms.

Most monkeypox patients recover without incident and no deaths have been reported. However, 13% required hospitalization primarily for pain management, difficulty swallowing, and bacterial superinfection. Hospitalization rates for HIV-positive and HIV-negative people were similar. At the time of reporting she was pregnant with two women and no complications have been reported so far.

Trans women were about twice as likely to be treated with tecovirimato as cis women (TPOXX), 34% vs 16%, respectively. Only six received monkeypox vaccination for post-exposure prophylaxis. Eight of her trans women and two of her cis women with monkeypox reported that they had received preexposure vaccines during this outbreak.

This international case series “provides valuable insight into the clinical features of monkeypox in women,” said co-author Dr. Boghuma Titanji of Emory University in Atlanta. “Importantly, it also shines a light on new areas of inequality that require urgent and targeted attention … As the monkeypox outbreak evolves, we will learn from these new lessons. We must draw out and take a more holistic approach to monkeypox in women.