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Sexual Exposures Associated With Mpox Infection: California, November 2022 to June 2023.

Robert E Snyder¹, Kayla Saadeh¹, Eric C Tang¹

¹Sexually Transmitted Diseases Control Branch, California Department of Public Health, Richmond and Sacramento, California, USA.

The Journal of Infectious Diseases

|October 11, 2023

Summary

Mpox infection risk increases with sexual exposure to contacts, even if they show no symptoms. Having more sex partners also elevates mpox risk, with transmission occurring even from asymptomatic individuals.

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Area of Science:

Epidemiology
Infectious Diseases
Public Health

Background:

Mpox (monkeypox) virus transmission routes and risk factors require further elucidation.
Understanding exposures is crucial for effective mpox prevention strategies.

Purpose of the Study:

To investigate specific behavioral and exposure-related risk factors for mpox infection.
To identify characteristics of transmission events, including asymptomatic or presymptomatic spread.

Main Methods:

A case-control study was conducted in California between November 2022 and June 2023.
Participants underwent molecular testing for mpox/orthopoxvirus.
Data on behaviors during a 21-day pre-symptom or pre-testing period were collected from case patients and test-negative controls.

Main Results:

Sexual exposure to individuals suspected of having mpox significantly increased infection risk (OR, 7.7).
Mpox transmission frequently occurred when "index contacts" lacked visible symptoms (OR, 14.9).
Increased numbers of sex partners and specific sexual practices (insertive anal/vaginal sex, receptive anal sex) were associated with higher mpox risk.

Conclusions:

Sexual contact with individuals suspected of mpox, particularly when asymptomatic, is a key risk factor.
Higher numbers of sexual partners and specific sexual behaviors correlate with increased mpox risk.
Findings suggest that mpox can be transmitted by individuals without apparent symptoms, highlighting challenges in partner notification and risk assessment.