Semen samples show prolonged shedding of virus DNA for weeks after symptoms onset
Photo: Wikimedia Commons Monkeypox virus in the current outbreak may be sexually transmissible, evidence has suggested. A study published in The Lancet on August 2 assessed viral shedding in semen samples collected 5–19 days after symptom onset in a patient.
The patient was diagnosed at Italy’s Lazzaro Spallanzani National Institute for Infectious Diseases. The ongoing outbreak has overwhelmingly been reported within a particular network — men who have sex with men (MSM).
The findings hint at a genital reservoir, meaning the virus may be habitating in the genital tract.
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“Prolonged shedding of monkeypox virus deoxyribonucleic acid (DNA) can occur in the semen of infected patients for weeks after symptoms onset,” the study found.
“Semen collected in the acute phase of infection (day 6 after symptom onset) may contain a replication-competent virus and represent a potential source of infection,” it said.
The 39-year-old man — who identifies as an MSM and a sex worker — began showing symptoms after he travelled to Austria in early May 2022. He had self-reported unsafe sexual intercourse (without using a condom) with several male partners the month before the trip.
The patient also lives with with human immunodeficiency virus (HIV) and had a history of sexually transmitted infections. He reported symptoms of fever, lesions in the anal region and solitary lesions on the head, thorax, legs, arms, hand and penis.
“The case discussed herein supports that transmission of monkeypox virus during sexual activity may be a viable and recognised route, especially in the current 2022 outbreak of disease,” the authors note.
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These findings come at the heels of the World Health Organization’s (WHO) Director-General Dr Tedros Adhanom Ghebreyesus’s suggestion to the MSM community to reduce the number of sex partners.
“For men who have sex with men, this includes, for the moment, reducing your number of sexual partners, reconsidering sex with new partners, and exchanging contact details with any new partners to enable follow-up if needed,” Tedros had said during the WHO’s weekly press conference on July 27.
The messaging shifted from being vague and evading any clarity on the risk the MSM community may face to bringing some clarity to how the outbreak is progressing. However, this led to the community being demonised, triggering the WHO to issue a clarification that they are not carriers of the disease.
“It is important to note that the risk of monkeypox is not limited to men who have sex with men. Anyone who has close contact with someone who is infectious is at risk,” the global health body said.
It is critical to not stigmatise the community, however, Boghuma Kabisen Titanji — medical doctor and clinical researcher from Cameroon — warned people to be careful.
“It’s important that new information is incorporated into public health messaging and we stop fighting each other over semantics. Close contact during sex and sexual transmission is possible. Let’s prevent these,” Titanji said on Twitter.
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Evidence of the monkeypox virus in the semen has been reported earlier as well. Eurosurveillance, a weekly peer-reviewed journal, published a report in June 2022 which noted.
These findings cannot be considered definitive evidence of infectivity, (but) they demonstrate viral shedding whose efficiency in terms of transmission cannot be ruled out.
The Lancet study also underlined the need for more studies. It called for further studies in viral tropism, or the ability of a given virus to productively infect a cell, tissue or host species.
“...Data on the frequency of virus detection and duration of replicative monkeypox virus shedding in the seminal fluid, also in patients who do not have HIV, are crucial to better understand the viral pathogenesis,” the authors added.
It will also help understand the potential role of semen-driven transmission in the spreading of monkeypox infection and disease burden, the report said.
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