During the global Monkeypox outbreak, case definitions have focused on sexually active men who have sex with other men.
This population is the focus of the public health response.
But as the outbreak gets worse, it’s important to also pay attention to groups that aren’t as well-known, like women and nonbinary people, to learn more about their risk.
Since this has not yet been documented, it is crucial to explain how monkeypox infection appears in women so that doctors can identify the illness.
An international group of experts led by Professor Chloe Orkin at Queen Mary University of London has released the first case study series of monkeypox infections during the 2022 outbreak in cisgender (cis) and transgender (trans) women and non-binary people who were assigned as female at birth.
The case series, which was released in The Lancet today, offers much-needed knowledge into the risk factors, modes of transmission, and other clinical characteristics of monkeypox infection.
These populations have been underrepresented in studies thus far, and very little is known about the ways in which the disease impacts women. These findings will shape the global response to the monkeypox outbreak.
This is the second case series of monkeypox from the international group. Their first paper, published this summer in The New England Journal of Medicine, found new clinical symptoms of monkeypox in men.
The research contributed to the development of worldwide case definitions and the response to monkeypox on a global scale.
The authors’ clinical summary of monkeypox for The Lancet Seminars, also released today, covered the ongoing monkeypox outbreak that is affecting people all throughout the world, but these case series offer the most thorough picture of it.
In this new study, clinicians across 15 countries provided data from 136 women (69 cisgender, 62 transgender) and five non-binary individuals with confirmed monkeypox infection between May 11 and October 4, 2022.
In the first case study series, nearly all (95–100%) of the males suspected sexual interaction as the method of transmission.
In the most recent research of women, most infections (73%), but not all, are likely to be transmitted through sexual contact.
These statistics provide critical insights when cis and trans women are separated out. For trans women, sexual contact is the most common method of transmission, although almost one-fourth of cis women in the study may have acquired monkeypox infection without sexual contact.
The clinical manifestations of the women was comparable to that of the men (mucosal sores and anal and genital sores).
Especially in cis women, these clinical symptoms were frequently misinterpreted as sexually transmitted infections (STIs).
While men and trans women were more likely to visit sexual health and HIV clinics, most cis women visited emergency rooms, primary care, and various hospital departments.
This underlines the importance of educating medical personnel outside of sexual health clinics in order to prevent the misdiagnosis of monkeypox symptoms and to stop further transmission.
Similarly to the global case series in men, which confirmed monkeypox viral DNA in 29/32 semen samples tested, this case report detected monkeypox viral DNA in 100% of vaginal swabs (14/14).
This increases the possibility of sexual transmission by skin-to-skin contact as well as bodily fluids. Despite the fact that 26% of cis women lived with children, just two children contracted monkeypox – a reassuring and significant finding given that children are more badly afflicted than adults.
What experts think about the findings of new study:
“This case series of monkeypox, which is the first to bring together cases from the global south and north, further illustrates that monkeypox is a problem for all genders and all regions,” says Dimie Ogoina, Professor and Infectious Disease Physician at the Niger Delta University Teaching Hospital, adding, “there is a need for more investment in surveillance, research and development to understand the differences and similarities in the clinical course and outcome of monkeypox in all affected regions, especially in Africa.”
“Individuals who identify as transgender, nonbinary and gender diverse are often absent from research representation,” adds research author Asa Radix, Senior Director of Research and Education at the Callen-Lorde Community Health Centre in NYC and co-chair of the World Professional Association of Transgender Health.
“The inclusion of transgender women and nonbinary individuals in this series,” according to the researcher, “illustrates the importance of demographic and outcome data being disaggregated by both sex and gender and is key to improving ongoing monkeypox surveillance and targeted public health interventions.”
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