Researchers describe viral shedding of monkeypox virus in sufferers to raised perceive the doable function of various bodily fluids in illness transmission
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In a current examine revealed in Eurosurveillance, researchers described the shedding of the monkeypox (MPX) virus (MPXV) in Barcelona metropolis of Spain.

Study: Frequent detection of monkeypox virus DNA in saliva, semen, and different medical samples from 12 sufferers, Barcelona, Spain, May to June 2022. Image Credit: FOTOGRIN/Shutterstock


MPX was initially detected within the Democratic Republic of Congo in 1970, and a subsequent non-endemic MPX outbreak occurred in 2003 within the United States (US). Thereafter, MPX was thought-about an rising infectious illness and a possible menace to public well being. To date, MPX continues to increase globally, with >9,000 confirmed MPX instances reported throughout 57 nations by July 11, 2022.

From 2018 to 2021, seven instances had been detected within the United Kingdom with MPXV deoxyribonucleic acid (DNA) detected in urine, blood, and nasopharyngeal samples. Additionally, 4 instances detected in Italy confirmed the presence of MPXV DNA in saliva, feces, and semen. The continuous upsurge of MPX instances warrants an extra understanding of MPXV shedding.

About the examine

In the current examine, researchers characterised MPX shedding to enhance understanding of the potential function of physique fluids in MPXV transmission.

The examine was carried out between May and June 2022, for which 147 samples comprising saliva, rectal swabs, semen, nasopharyngeal swabs, urine, and feces had been obtained from 12 MPXV-positive sufferers at 23 completely different time factors by real-time polymerase chain response (PCR). In addition, Sanger sequencing was carried out for the primary three identified MPX instances. Epidemiological and medical information had been retrieved from the sufferers’ medical data and had been reviewed retrospectively.

Samples had been obtained from two lesions for MPX analysis, and moreover, samples had been screened for different sexually transmitted infections (STIs) by PCR: Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae and within the rectum, urine, and pharynx, respectively. In addition, serological screening was carried out for Lymphogranuloma venereum, Treponema pallidum, and herpes virus in anal genital ulcers and human immunodeficiency virus (HIV), hepatitis B, and C viruses, and syphilis.

Results and dialogue

All members had been younger males who had intercourse with males (MSM), their median age was 38.5 years, most of them (9 sufferers) had prior STI historical past, and concurrent STIs had been reported amongst three members. All members had lively intercourse and had ≤10 sexual companions within the earlier month, seven of which had been taking HIV pre-exposure prophylaxis (PEP) drugs.

 Five members attended sex-on-premises or chemsex periods, and three members traveled inside Spain, though none of them visited Madrid or Canary Islands, the place MPXV transmission was initially detected within the nation. Four members had intercourse with confirmed instances of MPX, and 4 sufferers had acquired smallpox vaccination.

MPXV DNA was detected in saliva and pores and skin lesion swabs of all (12/12) instances, with excessive viral hundreds [quantification cycle (Cq) values ranging between 16 and 21] within the pores and skin pustules. In addition, MPXV DNA was detected in samples obtained between day 4 and day 16 following the onset of MPX signs.

Other samples had been incessantly MPXV-positive: nasopharyngeal swabs (10 instances), rectal swabs (11 instances), semen (seven instances), feces (eight instances), and urine (9 instances). Intermittent MPXV shedding (PCR-negative samples that grew to become PCR-positive) was noticed within the saliva and urine samples of two members.

The examine outcomes are in accordance with earlier research reporting MPXV DNA detection in semen, blood, nasopharyngeal swabs, saliva, and feces. Of curiosity, saliva was beforehand examined solely as soon as in a single affected person. In the current examine, MPXV DNA was detected in salivary samples of all sufferers obtained 4 to 16 days submit symptom onset.


Overall, the examine findings highlighted the routes of MPX transmission in Barcelona and enhanced data of MPXV shedding. The examine outcomes might present helpful data for MPX diagnostics and growing interventions for improved public well being. However, additional analysis have to be carried out to find out MPXV’s functionality to trigger proctitis and several other different uncommon medical manifestations.

In addition, future research with bigger pattern sizes should additional assess the infectivity of physique fluids and their potential function in MPX transmission by shut bodily contact throughout intercourse. Further, information on smallpox vaccination historical past from massive case sequence coupled with serological assessments must be analyzed to enhance data of the helpful function of smallpox vaccinations in defending in opposition to MPXV infections. Furthermore, the frequency of asymptomatic and secondary instances have to be assessed, and the affect of MPX on behavioral and social components affecting MPX transmission have to be evaluated.

Journal reference:

  • Peiró-Mestres, A. et al. (2022) “Frequent detection of monkeypox virus DNA in saliva, semen, and other clinical samples from 12 patients, Barcelona, Spain, May to June 2022”, Eurosurveillance, 27(28). doi: 10.2807/ material/10.2807/1560-7917.ES.2022.27.28.2200503

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