First study of monkeypox infection in Transgender women

An international collaboration of clinicians, has published the first case study series of monkeypox infection during the 2022 outbreak in cis gender (cis) and transgender (trans) women and non-binary individuals assigned as female at birth.

The case series, published in The Lancet, provides much needed insight into risk factors, routes of transmission and other clinical features of monkeypox infection. So far, these groups have been underrepresented in research and little is known about how the disease affects women. These data will help to guide the international response to the ongoing monkeypox outbreak.

In this latest study of women, sexual contact is likely to be the route of transmission for most (73%), but not all the cases. Differentiating between cis and trans women in these data reveals important insights; for example, sexual contact is the most common route of transmission for trans women, but nearly one-quarter of cis women in the study are suspected to have contracted monkeypox infection without sexual contact.

The women experienced a similar clinical presentation to what has been seen in men (mucosal sores and anal and genital sores). These clinical symptoms were frequently misdiagnosed as sexually transmitted infections (STIs), especially in cis women. While men and trans women were more likely to access sexual health and HIV clinics, most cis women attended a wider range of clinical settings including emergency departments, primary care and various hospital departments. This reinforces the need for education for health professionals beyond sexual health clinics to ensure that monkeypox symptoms are not misdiagnosed and to limit onward transmission.

This strengthens the likelihood of sexual transmission through bodily fluids as well as skin-to-skin contact. Although 26% of cis women lived with children, only two children acquired monkeypox - a reassuring and important finding, as children can be more severely affected than adults.

Reference:

John P Thornhill, MBBCh PhD, Romain Palich, MD PhD, Prof Jade Ghosn, MD PhD Prof Sharon Walmsley, MD MSc Davide Moschese, MD Claudia P Cortes, MD et al, Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series, The Lancet, DOI:https://doi.org/10.1016/S0140-6736(22)02187-0