While parts of Africa have been dealing with monkeypox for years, the virus became an international outbreak garnering global attention in the spring of 2022. Although cases in the U.S. hit their peak in late August, the virus is still on the move across the country and the world.1 As of October, over 71,000 cases of monkeypox have been reported worldwide this year, with over 26,000 presenting in the U.S.2 To curb the further spread of monkeypox, we must understand how the virus spreads and provide equitable access to proper testing and treatment solutions.
How Monkeypox Spreads
Monkeypox is caused by infection with monkeypox virus (MPXV), a member of the orthopoxvirus genus and a relative of the extinct smallpox (variola) virus. MPXVs themselves are classified into two groups with distinct geographic, genetic and clinical characteristics: Clades I and II. The single strain so far responsible for the 2022 global public health emergency belongs to Clade II.
The virus can be contracted through skin-to-skin contact, respiratory secretions such as saliva or mucus, or contaminated surfaces.3 A report from Spain showed frequent detection of MPXV DNA in saliva, semen and monkeypox lesions themselves.4 While it can affect anyone regardless of age, race/ethnicity or sexual orientation, most cases have been seen in men who have sex with men.3
Co-infections with STIs
According to a report by the CDC, monkeypox co-infections with HIV and other STIs are highly prevalent. Among 1,969 people who were diagnosed with monkeypox, 38% also had HIV, and 41% had at least one STI within the last 12 months.5 The report also showed that those with monkeypox/HIV co-infections were more likely to be hospitalized than those with monkeypox alone.5 Lesions typically associated with monkeypox can be confused with several STIs—monkeypox needs to be included on the differential diagnosis when a patient presents with an STI-like rash. Since the presence of an STI does not rule out monkeypox, the CDC suggests patients who fit the epidemiological criteria to get tested to prevent the spread of multiple infections.6
In addition to comprehensive testing for monkeypox, STIs and HIV, the CDC suggests taking additional preventive care measures to minimize transmission, including prioritizing those with HIV and/or other STIs when it comes to monkeypox vaccination.6
Testing to Slow the Spread
The lesbian, gay, bisexual, transgender, queer/questioning, intersex and asexual (LGBTQIA+) community—especially men who have sex with men—experience higher rates of HIV and other STIs while suffering from limited access to healthcare. Providing access to testing through public health efforts, community centers and sexual health clinics can help close the health equity gap while minimizing monkeypox outbreaks and other sexually transmitted or bloodborne infections.
Because these infections can share similar signs and symptoms, accurately diagnosing them is difficult without proper testing. Rapid, accurate diagnostics can identify the pathogen and the appropriate treatment in time to prevent further spread of monkeypox, STIs and/or other diseases.
By offering thorough preventive care measures such as multi-target testing to high-risk individuals and the general public, the healthcare industry can respond more quickly and effectively to the monkeypox virus, minimizing cases while improving patient outcomes.
How PRL Can Help
Several U.S. laboratories have begun offering PCR tests targeting only the genus, species or clade region of the monkeypox genome. However, standalone orthopoxvirus testing can lead to presumptive positive results, and standalone generic monkeypox or clade II testing can lead to false negative results due to mutant strains.7 Both the CDC and FDA recommend multi-assay panels to reduce missed diagnoses and eliminate the need to send out for confirmatory testing, thereby decreasing turnaround time.8
Pandemic Response Lab (PRL) recently launched a novel monkeypox test that simultaneously detects three unique genomic targets to confirm or rule out the presence of the virus at the genus, species and clade levels. We also offer a multi-target NAAT panel that detects three of the most common STIs: gonorrhea, chlamydia and trichomoniasis. PRL can help clinicians, hospitals and public health departments provide communities with comprehensive testing solutions for monkeypox, STIs and related co-infections.
Sources:
1. U.S. Monkeypox Case Trends Reported to CDC l Published 9/14/2022 l Accessed 9/19/2022. https://www.cdc.gov/poxvirus/monkeypox/response/2022/mpx-trends.html
2. 2022 Monkeypox Outbreak Global Map l Data as of 9/19/2022 l Accessed 9/20/2022. https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html
3. Clinical overviews │ Monkeypox. Monkeypox. https://elsevier.health/en-US/preview/monkeypox-co#reference-34. Published September 20, 2022. Accessed October 12, 2022.
4. Frequent detection of monkeypox virus DNA in saliva, semen, and other clinical samples from 12 patients, Barcelona, Spain l Published 7/14/2022 l Accessed 9/19/2022. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2022.27.28.2200503
5. HIV and Sexually Transmitted Infections Among Persons with Monkeypox l CDC l Published 9/9/2022 l Accessed 9/19/2022. https://www.cdc.gov/mmwr/volumes/71/wr/mm7136a1.htm
6. Clinician FAQs l CDC l Updated 10/3/2022 l Accessed 10/10/2022 https://www.cdc.gov/poxvirus/monkeypox/clinicians/faq.html#Clinical-Guidance
7. 09/02/2022: Lab Alert: MPXV TNF Receptor Gene Deletion May Lead to False Negative Results with Some MPXV Specific LDTs. https://www.cdc.gov/locs/2022/09-02-2022-lab-alert-MPXV_TNF_Receptor_Gene_Deletion_May_Lead_False_Negative_Results_Some_MPXV_Specific_LDTs.html. Published September 2, 2022. Accessed October 12, 2022.
8. FDA Advises Monkeypox Test Developers to Pick Multiple Targets. https://www.360dx.com/infectious-disease/fda-advises-monkeypox-test-developers-pick-multiple-targets. Published October 5, 2022. Accessed October 12, 2022.
