HIV, earlier STIs common in US monkeypox patients

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Surveillance data from eight US jurisdictions found a high prevalence of HIV and other sexually transmitted infections (STIs) among people with monkeypox, a research team based at the Centers for Disease Control and Prevention (CDC) reported today.

In other developments, scientists from Europe today reported finding viable monkeypox viruses in anal and urethral samples from monkeypox patients, adding more evidence for a sexual transmission route, and the US government took more steps to expand testing and explore the efficacy of different vaccination strategies.

Hospitalizations higher in those with HIV

The HIV and STI findings came from an analysis of 1,969 monkeypox cases diagnosed between May 17 and Jul 22 at eight HIV surveillance jurisdictions. The team published their findings today in Morbidity and Mortality Weekly Report (MMWR).

Of the group, 38% were infected with HIV and 41% had experienced an STI in the previous year. Also, 18% had both. Hospitalizations for monkeypox were more common in people with HIV.

People with HIV were more likely to report rectal pain and other rectal symptoms, which researchers said might relate to differences in site of exposure, increased susceptibility, or other factors, the group wrote.

The findings underscore the importance of leveraging systems for delivering HIV and STI care and prioritizing people with the two conditions for monkeypox vaccination. They also emphasized that those who haven't received routine HIV or STI care or those with milder symptoms might be less likely to have their monkeypox infections diagnosed. "It is important that health care providers who do not specialize in HIV or sexual health become familiar with the clinical guidance for monkeypox diagnosis and treatment," they wrote.

Live virus in anal and urethral swabs

Meanwhile, in another new research development, Italian researchers writing in Eurosurveillance today described their experience testing anal and urethral swab samples from confirmed cases by PCR testing and virus isolation.

The swabs were collected within 7 days of symptom onset. Replicating virus was found in 13 of 8 anal swabs and 11 of 15 urethral swabs. Two asymptomatic secondary cases had detectable monkeypox genetic material in urethral samples, with virus isolated from one of the patients, adding support for sexual transmission as a possible virus transmission route.

US actions to expand testing

The US government took more steps to expand monkeypox testing. Quest Diagnostics announced yesterday that the Food and Drug Administration (FDA) has granted emergency use authorization (EUA) for the company's lab-developed molecular test, the first for a commercially available monkeypox test.

It said the EUA designation follows a Sep 7 declaration under section 564 of the Federal Food, Drug, and Cosmetic Act by Health and Human Services Secretary Xavier Becerra. It allows the FDA commissioner to issue EUAs for in vitro diagnostics to expand tests for monkeypox.

In other monkeypox developments:

  • The National Institutes of Health (NIH) today announced that it will launch a clinical trial to test alternative strategies for administering the Bavarian-Nordic monkeypox vaccine (Jynneos) to expand available doses. The goal is to enroll more than 200 adults across eight US research sites.
  • The CDC yesterday reported 541 new monkeypox cases, raising the nation's total to 21,274.
  • Egypt reported its first case, which involves a 42-year-old man who regularly travels to Europe, according to Agence France-Presse (AFP).
  • In a monkeypox surveillance update yesterday, the European Centre for Disease Prevention and Control (ECDC) said notification rates are highest in Spain, Luxembourg, and Belgium. Cases are declining in 17 countries and are rising in 2: Sweden and Ireland.

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