International Collaboration of Clinicians, taught by Chloe Orkin, who founded and leads Queen Mary University of London, has published the first case study series of monkeypox infection in cisgender (cis) and transgender (trans) women, as well as non-binary gender individuals assigned female at birth, in 2022. case series, published today (November 17, 2022) on The Lancet
provides much-needed insight into risk factors, transmission routes, and other clinical features of monkeypox infection. Until now, these groups have been underrepresented in studies, and little is known about how the disease affects women. These data will help guide the international response to the ongoing monkeypox outbreak.
This is the second series of monkeypox cases in the international community, they are in The first paper this summer in the New England Journal of Medicine
identifies a new clinical sign of monkeypox in men. The research proved influential in shaping international case definitions, thereby contributing to the global response to monkeypox. These case series provide the most comprehensive picture of an ongoing outbreak of monkeypox worldwide, which the authors report in Clinical Overview of Monkeypox at The Lancet Seminars
In the first case study series, sexual contact was the suspected transmission in almost all (95-100%) of the males way. In the latest study of women, sexual contact was probably the route of transmission for most (73%), but not all cases. Distinguishing between cis and trans women in these data revealed important insights; for example, sexual contact was the most common route of transmission for trans women, yet nearly a quarter of cis women in the study were suspected infected with monkeypox.
Women experienced similar clinical manifestations (mucosal ulcers, anal and genital ulcers) as men. These clinical signs are often misdiagnosed as a sexually transmitted infection (STI), especially in cisgender women. While men and transgender women were more likely to seek help from sexual health and HIV clinics, most cisgender women were seen in broader clinical settings, including emergency departments, primary care, and various hospital departments. This reinforces the need to educate health professionals outside sexual health clinics to ensure monkeypox symptoms are not misdiagnosed and to limit onward transmission.
Monkeypox DNA was detected in 29/32 semen samples similar to the global male case series, which Monkeypox virus DNA was found in 100% of vaginal swabs (14/14). This increases the likelihood of sexual transmission through bodily fluids and skin-to-skin contact. Although 26 percent of cis women lived with children, only two children were infected with monkeypox—a reassuringly important finding because children can be more severely affected than adults.
study lead author Chloe Orkin, Professor of HIV Medicine at Queen Mary University of London and Director of the SHARE Collaborative, said, “In During the global outbreak, case definitions correctly focused on the most affected group, active men who have sex with men. The public health response has been tailored to this group. However, as the outbreak has progressed, important It is also important to focus on underrepresented groups such as women and non-binary individuals to better understand their risk. It is important to describe how infection manifests in women because until now it has not been clearly characteristics, physicians need to be able to recognize the disease. This knowledge will help inform and tailor effective public health measures to accommodate these groups.”
Dimie Ogoina, professor and infectious disease physician at the Niger Delta University Teaching Hospital, said, “This monkeypox case series, the first to bring together cases from the global southern and northern hemispheres, further demonstrates that monkeypox is a disease of all genders and A problem in all regions. More investment in surveillance, research and development is needed to understand the similarities and differences in the clinical course and outcome of monkeypox in all affected regions, especially in Africa.”
Study author Asa Radix, senior director of research and education at the Callen-Lorde Community Health Center in New York City and co-chair of the World Professional Association for Transgender Health, said, “Individuals who Being transgender, non-binary and gender-diverse people are often not represented in the study representation. The inclusion of transgender women and non-binary individuals in the series illustrates the importance of sex- and sex-disaggregated demographic and outcome data and is key to improving ongoing monkeypox surveillance and targeted public health interventions.” Further information:
Human Monkeypox 2022 Outbreak in Females and Non-Binary Individuals Viral Infections: A Global Case Series, The Lancet
(2022). www.thelancet.com/journals/lan… (22)02187-0/fulltext
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