Evidence map›Paper›PMID 36403584›Full record

ArticleLancet (London, England)2022

Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series.

John P Thornhill, Romain Palich, Jade Ghosn, Sharon Walmsley, Davide Moschese, Claudia P Cortes, Rafael Mello Galliez, Amy B Garlin, Silvia Nozza, Oriol Mitja and 33 more

Open access · bronzeAbstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in Lancet (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 92 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
92citing papers in PubMed, 6 pooled it
10.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

92 citing papers in PubMed, 6 syntheses or guidelines pooled it, 144 citations in OpenAlex.

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  8. A comprehensive overview of monkeypox virus disease.Tropical medicine and health · 2026
    Review
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32 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

43 authors at 20 institutions in 16 countries.

John P ThornhillDepartment of Infection and Immunity, Blizard Institute and SHARE Collaborative, Queen Mary University of London, Barts Health NHS Trust, London, UK.
Romain PalichInfectious Diseases Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre Louis Epidemiology and Public Health Institute, Sorbonne University, INSERM 1136, Paris, France.
Jade GhosnDepartment of Infectious Diseases, Bichât University Hospital, Assistance Publique-Hôpitaux de Paris Nord, Université Paris Cité, INSERM U1137, IAME, Paris, France.
Sharon WalmsleyUniversity Health Network, University of Toronto, Toronto, ON, Canada.
Davide MoscheseDepartment of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.
Claudia P CortesFaculty of Medicine, University of Chile, Santiago, Chile.
Rafael Mello GalliezNúcleo de Enfrentamento e Estudos de Doenças Infecciosas Emergentes e Reemergentes, Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Amy B GarlinDisease Prevention and Control Branch, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA; Division of Infectious Diseases and Vaccinology, Berkeley School of Public Health, University of California, San Francisco, CA, USA.
Silvia NozzaDepartment of Infectious and Tropical Diseases, IRCCS-Ospedale San Raffaele, Milan, Italy.
Oriol MitjaSkin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain.
Asa E RadixDepartment of Medicine, Callen-Lorde Community Health Center, NYU Grossman School of Medicine, New York, NY, USA.
Jose Luis BlancoServicio de Enfermedades Infecciosas, Hospital Clinic de Barcelona, Universidad de Barcelona, Instituto para la Investigación Médica August Pi I Suñe, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
Brenda Crabtree-RamirezDepartamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.
Melanie ThompsonThacker & Thompson MD, Atlanta, GA, USA.
Lothar WieseDepartment of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark.
Hubert SchulbinPraxis Kreuzberg Clinic, Berlin, Germany.
Ariela LevcovichShamir (Assaf Harofe) Medical Centre, Tel Aviv, Israel.
Marco FalconeInfectious Diseases Unit, Cisanello University Hospital, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Anna LucchiniSexual Health Clinic, National Health Service, Torino, Italy.
Elena SendagortaServicio de Dermatología, Hospital Universitario La Paz, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.
Carl-Johan TreutigerDepartment of Infectious Diseases/Venhälsan, South General Hospital, Stockholm, Sweden.
Ruth ByrneChelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Katherine CoyneHomerton Healthcare Trust, London, UK.
Eric A MeyerowitzMontefiore Medical Center, New York, NY, USA.
Anna M GrahnDepartment of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
Ann-Brit Eg HansenDepartment of Infectious Diseases, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.
Valerie PourcherInfectious Diseases Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre Louis Epidemiology and Public Health Institute, Sorbonne University, INSERM 1136, Paris, France.
Michelle DellaPiazzaDivision of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA.
Rachel LeeGeorge Washington University Hospital, Washington, DC, USA.
Marcel StoeckleDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Aniruddha HazraSection of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA.
Vanessa ApeaDepartment of Global Health, Wolfson Institute and SHARE Collaborative, Queen Mary University of London, Barts Health NHS Trust, London, UK.
Emma RubensteinDepartment of Infectious Diseases, Saint-Louis and Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Joyce JonesDivision of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Aimee WilkinWake Forest University School of Medicine, Winston-Salem, NC, USA.
Anuradha GanesanInfectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, The Henry M Jackson Foundation for the Advancement of Military Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Andrés F Henao-MartínezUniversity of Colorado Anschutz Medical Campus, Aurora, USA.
Eric J ChowPublic Health-Seattle & King County, Seattle, WA, USA; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Epidemiology, University of Washington, Seattle, Washington, USA.
Boghuma K TitanjiDepartment of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
Jason E ZuckerColumbia University Irving Medical Center, New York, NY, USA.
Dimie OgoinaInfectious Diseases Unit, Department of Internal Medicine, Niger Delta University, Amassoma, Niger; Niger Delta University Teaching Hospital, Okolobir, Bayelsa, Nigeria.
Chloe M OrkinDepartment of Infection and Immunity, Blizard Institute and SHARE Collaborative, Queen Mary University of London, Barts Health NHS Trust, London, UK. Electronic address: c.m.orkin@qmul.ac.uk.
Share-Net writing group
Inserm · FRQueen Mary University of London · GBAssaf Harofeh Medical Center · ILAssistance Publique – Hôpitaux de Paris · FRChelsea and Westminster Hospital NHS Foundation Trust · GBColumbia University Irving Medical Center · USCommunity Health Center · USEmory University · USFundació Lluita contra les Infeccions · ESGeorge Washington University Hospital · USHenry M. Jackson Foundation · USHospital Universitario La Paz · ESHvidovre Hospital · DKInstituto de Salud Carlos III · ESInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán · MXIRCCS Ospedale San Raffaele · ITJohns Hopkins University · USLuigi Sacco Hospital · ITMontefiore Medical Center · USNiger Delta University · NG

Funding

Columbia Partnership for Prevention and Control of HIV/AIDS Clinical Trials UnitUM1AI069470 · NIAID · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI MAGDALENA ELZBIETA SOBIESZCZYK · 2012 to 2026
$44.8M
Columbia Collaborative HIV/AIDS Clinical Trials UnitU01AI069470 · NIAID · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI HAMMER, SCOTT M · 2007 to 2011
$15.4M
HOST DEFENSE TRAINING IN ALLERGY AND INFECTIOUS DISEASEST32AI007044 · NIAID · UNIVERSITY OF WASHINGTON · PI DAVID Neal FREDRICKS · 1985 to 2026
$14.6M
Harnessing Bioinformatics for HIV Prevention: Understanding Persistence in Comprehensive HIV Prevention ServicesK23AI150378 · NIAID · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI ZUCKER, JASON · 2020 to 2024
$960k
NIAID NIH HHS K23 AI150378NIAID NIH HHS T32 AI007044NIAID NIH HHS U01 AI069470NIAID NIH HHS UM1 AI069470
6 · The paper itself

Abstract

backgroundBetween May and November, 2022, global outbreaks of human monkeypox virus infection have been reported in more than 78 000 people worldwide, predominantly in men who have sex with men. We describe the epidemiological and clinical characteristics of monkeypox virus infection in cisgender (cis) and transgender (trans) women and non-binary individuals assigned female sex at birth to improve identification and understanding of risk factors.

methodsInternational collaborators in geographical locations with high numbers of diagnoses of monkeypox virus infection were approached and invited to contribute data on women and non-binary individuals with confirmed monkeypox virus infection. Contributing centres completed deidentified structured case-report spreadsheets, adapted and developed by participating clinicians, to include variables of interest relevant to women and non-binary individuals assigned female at birth. We describe the epidemiology and clinical course observed in the reported infections.

findingsCollaborators reported data for a total of 136 individuals with monkeypox virus infection who presented between May 11 and Oct 4, 2022, across 15 countries. Overall median age was 34 years (IQR 28-40; range 19-84). The cohort comprised 62 trans women, 69 cis women, and five non-binary individuals (who were, because of small numbers, grouped with cis women to form a category of people assigned female at birth for the purpose of comparison). 121 (89%) of 136 individuals reported sex with men. 37 (27%) of all individuals were living with HIV, with a higher proportion among trans women (31 [50%] of 62) than among cis women and non-binary individuals (six [8%] of 74). Sexual transmission was suspected in 55 (89%) trans women (with the remainder having an unknown route of transmission) and 45 (61%) cis women and non-binary individuals; non-sexual routes of transmission (including household and occupational exposures) were reported only in cis women and non-binary individuals. 25 (34%) of 74 cis women and non-binary individuals submitted to the case series were initially misdiagnosed. Overall, among individuals with available data, rash was described in 124 (93%) of 134 individuals and described as anogenital in 95 (74%) of 129 and as vesiculopustular in 105 (87%) of 121. Median number of lesions was ten (IQR 5-24; range 1-200). Mucosal lesions involving the vagina, anus, or oropharynx or eye occurred in 65 (55%) of 119 individuals with available data. Vaginal and anal sex were associated with lesions at those sites. Monkeypox virus DNA was detected by PCR from vaginal swab samples in all 14 samples tested. 17 (13%) individuals were hospitalised, predominantly for bacterial superinfection of lesions and pain management. 33 (24%) individuals were treated with tecovirimat and six (4%) received post-exposure vaccinations. No deaths were reported.

interpretationThe clinical features of monkeypox in women and non-binary individuals were similar to those described in men, including the presence of anal and genital lesions with prominent mucosal involvement. Anatomically, anogenital lesions were reflective of sexual practices: vulvovaginal lesions predominated in cis women and non-binary individuals and anorectal features predominated in trans women. The prevalence of HIV co-infection in the cohort was high.

fundingNone.

Indexed as

Mpox, MonkeypoxSexual and Gender MinoritiesAdultAgedAged, 80 and overDisease OutbreaksFemaleGender-Nonconforming PersonsHomosexuality, MaleHumansMaleMiddle AgedMonkeypox virusYoung Adult

Identifiers

PMID36403584
PMCPMC9671743
OpenAlexW4309487276

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.