Study describes monkeypox in women; CDC warns of Tpoxx resistance

Monkeypox lesions on hands and arms
Monkeypox lesions on hands and arms

Marina Demidiuk / iStock

The first global case study of monkeypox in female patients suggests that as much as 25% of infections in women are not linked to sexual transmission.

The study, published yesterday in The Lancet, was performed by the same UK-based group that produced a study of male patients earlier this year. The current case study looks at 136 case-patients with monkeypox virus infection diagnosed between May 11 and Oct 4, 2022, across 15 countries.

"Although women account for a minority of infections reported in the current monkeypox outbreak (<5%), we anticipate that this might change as the outbreak evolves," the authors warn.

The overall median age was 34 years (range, 19 to 84), and the case-patients included 62 trans women, 69 cis women, and 5 nonbinary individuals who were born female.

A total of 121 out of 139, or 89%, of the case-patients reported having sexual intercourse with men before contracting the virus; sexual transmission was suspected in 55 (89%) of the trans women and 45 (61%) cis women and nonbinary individuals. The remaining cases in trans and cis women had an unknown route of transmission.

Only cis and nonbinary women reported non-sexual routes of transmission, including household and occupational exposure. Large group events, including Pride events, were not a predominant transmission activity, as they have been in men. Only 7% of all individuals in the study attended LGBTQ+ Pride or other large gatherings in the month preceding symptom onset, the authors said.

In total, 74% of cases in women were likely caused by sexual contact, compared to 95% to 100% reported in the authors’ case series on men.

One third of cis women initially misdiagnosed

The authors of the study point out that in cis women, genital rash and mucosal lesions were often misdiagnosed as other sexually transmitted infections: 25 (34%) of 74 cis women and nonbinary individuals in the case series were initially misdiagnosed.

"It is important to describe how the infection manifests in women as this has not been characterized until now and doctors need to be able to recognize the disease. These learnings will help inform and tailor effective public health measures to be inclusive of these groups," said lead author Chloe Orkin, PhD, of Queen Mary University of London, in a press release.

Similar to men, a high proportion of females in the case study were also HIV positive, with 37 (27%) of all individuals living with HIV and a higher proportion among trans women (31 of 62; 50.0%) than among cis women and nonbinary individuals (6 of 74; 8.1%).

Although 26% of cis women lived with children, only two children acquired monkeypox, which the authors said was a reassuring finding.

CDC warns of Tpoxx resistance

Yesterday, the Centers for Disease Control and Prevention (CDC) sent a Health Alert Network notice to health providers about two cases of Tpoxx resistance in people treated for monkeypox. Both had underlying immunocompromising conditions.

Resistance to tecovirimat (Tpoxx) has been rare and mostly associated with long courses of use. The two patients had, "progressive monkeypox infection despite prolonged treatment (>14 days) with tecovirimat. Both patients required inpatient treatment. These are the first known cases of monkeypox with laboratory-confirmed tecovirimat resistance in the United States," the CDC said. The

The CDC yesterday reported 25 more monkeypox cases, raising the national total to 29,080.

Finally in US news, Los Angeles County has reported a second death involving someone infected with monkeypox. The county is, however, noting a significant drop in cases, with just 3 cases per day being reported, compared to 20 per day 2 months ago.

Ohio is also reporting the second death of a monkeypox patient. The Ohio patient had underlying health conditions.

The United States has reported 11 deaths in people with monkeypox during the current outbreak.

This week's top reads