French Researchers Finds Monkeypox Virus In Anorectal Samples Of Gay Men Who Were Asymptomatic!
The Monkeypox crisis is expected to escalate as it seems that current protocols in certain countries to only test and treat individuals who display symptoms might not be the right move as more mounting evidence is showing that many asymptomatic infections out there that are going undetected and are helping to spread the disease unknowingly. Furthermore, no one knows what are the long-term effects of the monkeypox
infection even after symptoms resolve. Even more worrisome is that already there is now emerging evidence of viral persistence of monkeypox virus and even ‘reactivation’ of the virus weeks after symptoms resolve as many physicians are reporting of such incidences in the U.S., UK and also in Spain.
The current monkeypox (MPXV) outbreak initially emerged in May 2022, affecting mostly men who have sex with men (MSM).
Though most infections were characterized by cutaneous lesions, an earlier Belgium study reported 3 asymptomatic men with no cutaneous lesions but with positive results on anorectal MPXV polymerase chain reaction (PCR) testing. https://www.medrxiv.org/content/10.1101/2022.07.04.22277226v1
The current French study team says that determining whether MPXV infection can be asymptomatic may better inform epidemic management.
The main aim of their study was to assess the presence of MPXV in anorectal samples among asymptomatic MSM routinely tested for bacterial sexually transmitted infections.
The study team retrospectively performed testing for MPXV on all anorectal swabs that were collected in our center as part of a screening program for Neisseria gonorrhoeae and Chlamydia trachomatis. Per French guidelines, this screening is performed every 3 months among MSM with multiple sexual partners who are either taking HIV preexposure prophylaxis (PrEP) or living with HIV and receiving antiretroviral treatment.
The study participants could have urine samples and anal swabs collected at the clinic or a private laboratory.
The study team reported on asymptomatic MSM who tested negative for N gonorrhoeae and C trachomatis on MPXV anal swabs collected at the Infectious Disease Department and the Sexual Health Clinic of Bichat-Claude Bernard Hospital in Paris, France, from 5 June to 11 July 2022.
All study participants attended a clinical visit on the day of sampling as part of routine PrEP or HIV treatment follow-up. Participants gave written informed consent to have their data recorded in Nadis (www.dataids.org; Fedialis Medica, CNIL number 1171457, an electronic medical record designed for follow-up of persons living with HIV or receiving HIV PrEP and use of their data for research. The local review board did not require specific consent to use remnant routine biological samples in the setting of the MPXV epidemic.
In the study, after heat inactivation (12 minutes at 70 °C), nucleic acids were extracted using a STARMag 96 X 4 Universal Cartridge Kit (Seegene) on the MICROLAB NIMBUS system (Seegene). MPXV-specific PCR was performed using a previously published protocol
During the study period, 706 MSM visited the clinic, 383 had symptoms suggestive of MPXV infection (40% had anal lesions), and MPXV infection was confirmed in 271 of those with symptoms.
Screening for C trachomatis and N gonorrhoeae infection was not performed when MPXV infection was
suspected because of laboratory biosafety restrictions.
Of the 706 MSM, 323 had no MPXV symptoms, and 213 had anal swabs collected and were negative for C trachomatis and N gonorrhoeae.
Among these 213 MSM, the median age was 38 years (IQR, 29 to 48 years), and 110 (52%) were living with HIV and receiving antiretroviral therapy, with a median of 9 years (IQR, 4 to 18 years) since diagnosis. Among those with HIV, 78% had undetectable viral load (median viral load was 74 copies/mL [IQR, 37 to 2270 copies/mL] in the others), and the median last CD4 T-cell count was 0.766 × 109 cells/L (IQR, 0.560 to 1.001 × 109 cells/L).
MPXV PCR was successfully performed on 200 of 213 anal swabs and was positive in 13 (6.5%). Of those testing positive, 8 were living with HIV; all had undetectable HIV-1 viral load, and all had a CD4 T-cell count above 0.500 × 109 cells/L, except 1 who had a CD4 T-cell count of 0.123 × 109 cells/L.
The study team contacted all 13 MPXV-positive participants who were initially asymptomatic to assess symptom status and advised them to limit sexual activity for 21 days after the test date and to notify their recent sexual partners. None reported symptoms suggestive of MPXV infection, but 2 subsequently presented to our clinic with symptoms. One had a cycle threshold (Ct) value of 20.7 on PCR of the sample taken during the asymptomatic stage and a Ct value of 33.0 seven days later, when he presented with anal rash. The other presented with pharyngitis and fever but no anal symptoms; PCR on the anal swab taken during the asymptomatic phase showed a Ct value of 38.2, and PCR on a pharyngeal swab 9 days later showed a Ct value of 24.
Interestingly, of the 187 asymptomatic participants who tested negative for MPXV, 3 presented to our clinic more than 3 weeks after the initial MPXV-negative anal swab with symptoms suggestive of MPXV infection and tested positive.
The study findings indicate positive MPXV PCR results from anal samples in asymptomatic MSM. Whether this indicates viral shedding that can lead to transmission is unknown. If so, the practice of ring postexposure vaccination around symptomatic persons with probable or confirmed MPXV infection may not be sufficient to contain spread.
Recent French recommendations have advised vaccination for all MSM with multiple partners.
The study findings were published in the peer reviewed journal: Annals of Internal Medicine. https://www.acpjournals.org/doi/10.7326/M22-2183
Besides the important take away that suggest that vaccination limited to those with known exposure to the monkeypox virus may not be an effective strategy for preventing infection, it is interesting to note that many gay men who are HIV positive are mostly likely to contract Monkeypox and were still having sex in communal settings or with multiple partners! It is also questionable as to whether these immunocompromised individuals are helping the monkeypox virus to further evolve and mutate.
To date, many hypocrites are claiming that it is wrong to single out that the gay and bisexual communities are helping to spread the disease and worse, there has been no attempts to shut down premises that are promoting or encouraging group or public gay sex ie gay dungeons, gay saunas, gay chemsex parties, gay cruising joints etc. Certain Western mainstream media have even stated that it would be a futile task to get the gay community from refraining from sex for the time being during this monkeypox outbreak.
To date, almost 97 percent of those infected out of the 36,958 cases globally (as of the last 30 minutes) have been gay or bisexual men with a a small proportion of women who have either had sex with bisexual men, or are married to ‘closeted’ gays or bisexual men or are sex workers themselves. A few contracted the disease via contaminated surfaces or articles in household settings with infected individuals. A few children have also contracted the disease, most probably through surface or material contamination and hopefully not through sexual abuse! The fact remains that the gay community has helped spread the disease to the mainstream population.
Worse, there is no clear proof that the current monkeypox vaccines that are being used are really effective and many gay men are simply assuming that once vaccinated they are safe and its ok to be out and indulging in group or communal sex with multiple partners! It is only a matter of time before a vaccine resistant variant emerges!
With millions already with a dysfunctional immune system due to the ongoing COVID-19 pandemic and also with many even having COVID-19 induced immunodeficiency, pathogens like the monkeypox are going to be able to wreak havoc among populations very easily and rapidly. It will be interesting in coming months as many anticipate even newer lethal variants of the monkeypox virus is likely to emerge. To date, there has only been 13 reported deaths from the current monkeypox outbreak but there is a high possibility that this will change in coming months and similarly, do not even be surprised to hear words like re-infections and mutations more often in the monkeypox context!
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