Demographic and clinical characteristics of people diagnosed with active sexually transmitted infections among monkeypox cases in Brazil: the 2022 outbreak

Souza, Isabella Nepomuceno de; Pascom, Ana Roberta Pati; Spinelli, Matheus Funke; Dias, Guilherme Borges; Barreira, Draurio; Miranda, Angélica Espinosa

doi:10.1590/S1678-9946202466020

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BRIEF COMMUNICATION • Rev. Inst. Med. trop. S. Paulo 66 • 2024 • https://doi.org/10.1590/S1678-9946202466020 copy

Demographic and clinical characteristics of people diagnosed with active sexually transmitted infections among monkeypox cases in Brazil: the 2022 outbreak

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The worldwide monkeypox (mpox) outbreak in 2022 showed a high frequency of sexually transmitted infections (STI). A cross-sectional study was carried out using secondary data from the Brazilian official mpox surveillance systems. A total of 10,169 mpox cases were identified, with a median age of 32 years. Among them, 92.3% were male at birth and 57.5% were men who have sex with other men (MSM). Approximately 11% were diagnosed with STI, including 5.8% with syphilis and 2.5% with genital herpes. Individuals aged from 25 to 34 years, MSM, individuals with HIV-positive status, and those manifesting skin eruptions or penile edema were associated with STI. Laboratory investigation for mpox must be implemented as a priority in STI clinics (especially for MSM) to mitigate neglected cases, ensure appropriate treatments, and prevent misdiagnoses.

KEYWORDS
Sexually transmitted infections; Monkeypox; Surveillance

Demographic characteristic	Mpox cases		Mpox cases diagnosed with an STI % cases with an STI
Demographic characteristic	N	%	N	%
Total	10,169	100.0	1,099	10.8
Sex at birth
Male	9,386	92.3	1,071	11.4
Female	762	7.5	28	3.7
NA	21	0.2	0	0.0
Gender
Transgender women or tranvestites	54	0.5	10	18.5
Cisgender female	648	6.4	25	3.9
Cisgender male	7,328	72.1	904	12.3
Non-binary	78	0.8	13	16.7
Other	257	2.5	36	14.0
Missing/NA	1,804	17.7	111	6.2
Age
Md (Q1-Q3)	32 (27–38)		32 (27–37)
15-24	1,431	14.1	131	9.2
25-34	4,706	46.3	571	12.1
35-49	3,508	34.5	368	10.5
50+	524	5.2	29	5.5
Ethnicity/skin color
White/Yellow	4,113	40.4	407	9.9
Black	3,935	38.7	521	13.2
Indigenous	16	0.2	2	12.5
Missing/NA	2,105	20.7	169	8.0
Region of residence
North	482	4.7	84	17.4
Northeast	1,241	12.2	111	8.9
Southwest	6,253	61.5	611	9.8
South	1,044	10.3	131	12.5
Central-West	1,127	11.1	157	13.9
vMissing/NA	22	0.2	5	22.7
Sexual orientation
Heterosexual	768	7.6	56	7.3
Homosexual	3,536	34.8	531	15.0
Bisexual	575	5.7	85	14.8
Pansexual	76	0.7	12	15.8
Other	410	4.0	29	7.1
Female at birth	762	7.5	28	3.7
Missing/NA	4,042	39.7	358	8.9
Men who have sex with men*
No	1,007	9.9	67	6.7
Yes	5,844	57.5	792	13.6
Female at birth	783	7.7	28	3.6
Missing/NA	2,535	24.9	212	8.4

Demographic characteristic	Mpox cases		Mpox cases diagnosed with an STI % cases with an STI
Demographic characteristic	N	%	N	%
Total	10,169	100.0	1,099	10.8
STI
Syphilis	587	5.8
Genital herpes	252	2.5
Chlamydia	45	0.44
Gonorrhea	43	0.42
Genital warts	41	0.40
Other	131	1.3
None	3,871	38.1
NA	5,199	51.1
Immunosuppressed
No	5,104	50.2	476	9.3
Yes	2,869	28.2	549	19.1
Missing/NA	2,196	21.6	74	3.4
Living with HIV
No	4,055	39.9	365	9.0
Yes	3,595	35.4	648	18.0
Missing/NA	2,519	24.8	86	3.4
Hospitalization
No	4,133	40.6	511	12.4
Yes	114	1.1	17	14.9
Missing/NA	5,922	58.2	571	9.6
Symptoms
At least one	9,449	92.9	1,059	11.2
Bleeding	120	1.2	24	20.0
Penile edema	489	4.8	88	18.0
Mucosa lesion	350	3.4	59	16.9
Genital legion	2,280	22.4	335	14.7
Oral lesion	550	5.4	80	14.5
Generalized lymphadenopathy	1,335	13.1	181	13.6
Sweating/shivering	1,411	13.9	184	13.0
Anal lesion	1,993	19.6	258	12.9
Rash	4,640	45.6	591	12.7
Sore throat	1,448	14.2	183	12.6
Adenomegaly	3,767	37.0	466	12.4
Fever	5,950	58.5	697	11.7
Other symptoms	6,729	66.2	787	11.7

Demographic and clinical characteristic	OR(95%CI)	aOR(95%CI)
Sex at birth
Male	3.38(2.30–4.95)
Female	1.00	NS
NA	-
Gender
Transgender women or tranvestites	5.66(2.56–12.54)	2.24(0.85–5.91)
Cisgender female	1.00	1.0
Cisgender male	3.51(2.34–5.26)	1.45(0.72–2.92)
Non-binary	4.98(2.43–10.21)	1.93(0.77–4.80)
Other	4.06(2.38–6.92)	1.86(0.86–4.03)
Missing/NA	1.63(1.05–2.55)	1.02(0.50–2.06)
Age
15-24	1.72(1.14–2.61)	1.85(1.21–2.84)
25-34	2.36(1.60–3.47)	2.02(1.36–3.00)
35-49	2.00(1.35–2.95)	1.70(1.14–2.53)
50+	1.00	1.0
Ethnicity/skin color
White/Asian	1.00	1.0
Black	1.39(1.21–1.59)	1.26(1.08–1.46)
Indigenous	1.30(0.29–5.74)	1.13(0.25–5.19)
Missing/NA	0.79(0.66–0.96)	0.92(0.76–1.13)
Region of residence
North	2.15(1.58–2.92)	1.55(1.13–2.12)
Northeast	1.00	1.00
Southwest	1.10(0.89–1.37)	1.37(1.08–1.73)
South	1.46(1.12–1.91)	1.48(1.11–1.95)
Central-West	1.65(1.27–2.13)	1.37(1.05–1.79)
Missing/NA	2.99(1.08–8.27)	4.54(1.5–13.78)
Sexual orientation
Heterosexual	1,0	NS
Homosexual	2.25(1.69–2.99)
Bisexual	2.21(1.54–3.15)
Pansexual	2.38(1.22–4.68)
Other	0.97(0.61–1.54)
Female at birth	0.49(0.3–0.77)
Missing/NA	1.24(0.92–1.66)
Men who have sex with men*
No	1.00	1.00
Yes	2.20(1.70–2.85)	1.57(1.20–2.05)
Female at birth	0.52(0.33–0.82)	0.84(0.42–1.70)
Missing/NA	1.28(0.97–1.70)	1.16(0.86–1.57)
Immunosuppressed	1.0
No	2.30(2.02–2.75)	NS
Yes	0.34(0.26–0.44)
Missing/NA	1.0
Living with HIV	1.0	1.0
No	2.22(1.94–2.55)	1.72(1.36–2.18)
Yes	0.36(0.28–0.45)	0.64(0.48–0.85)
Missing/NA	1.0	1.0
Hospitalization
No	1.0	1.0
Yes	1.58(1.23–2.02)	1.51(1.16–1.95)
Missing/NA	0.73(0.60–0.88)	0.89(0.72–1.09)
Symptoms**
Bleeding	2.09(1.33–3.28)	NS
Penile edema	1.88(1.48–2.39)	1.34(1.04–1.74)
Mucosa lesion	1.71(1.28–2.28)	NS
Genital legion	1.61(1.40–1.84)	NS
Oral lesion	1.44(1.12–1.84)	NS
Generalized lymphadenopathy	1.35(1.14–1.60)	NS
Sweating/shivering	1.29(1.09–1.52)	NS
Anal lesion	1.30(1.12–1.51)	NS
Rash	1.44(1.27–1.64)	1.22(1.04–1.42)
Sore throat	1.23(1.04–1.46)	NS
Adenomegaly	1.29(1.13–1.46)	NS
Fever	1.26(1.11–1.43)	NS
Other symptoms	1.33(1.16–1.52)	NS

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[1] Correspondence to: Isabella Nepomuceno de Souza Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis, Edifício PO 700, SRTVN, 5º Andar, CEP 70655-775, Asa Norte, Brasília, DF, Brazil. E-mail:isabella.souza@aids.gov.br