Italian researchers isolate monkeypox virus from semen of patient with prolonged viral shedding

monkeypox virus. © Flickr

Italian researchers report, in an article published on August 2, 2022 on the journal’s website Lancet Infectious Diseasesthat isolated the monkeypox virus in the semen of a patient and observed, for a long time, the presence of this infectious virus capable of replication.

The patient in question is a 39-year-old man who traveled to Austria in the first two weeks of last May. He said he had sex with other men and a sex worker and said he had sex without a condom last month.

Infected with the AIDS virus (HIV), he received antiretroviral treatment (doglutavir and lamivudine). He was hospitalized five days after the onset of symptoms. In addition to the appearance of fever, several groups of papular lesions, accompanied by itching, appear in the anal region. Isolated lesions are also present on the head, thorax, legs, arms and genitals. More than thirty years ago, the patient was vaccinated against smallpox.

The presence of monkeypox virus DNA was detected by PCR in skin lesion and scab samples taken five days after the onset of symptoms.*. Researchers from the National Institute of Infectious Diseases ‘Lazzaro Spallanzani’ (IRCCS, Rome) succeeded in isolating the virus from a swab sample taken from a scalp lesion. In addition, plasma, urine and semen samples were collected to determine the duration of virus release in these biological fluids.

Monkeypox virus DNA was only detected in plasma collected eight days after the onset of symptoms. All urine samples were negative. In contrast, monkeypox virus DNA was found in all semen samples.**until the 19th day after the onset of symptoms.

The cells (Vero E6) were incubated in the presence of sperm collected on the sixth day after the onset of symptoms. Forty hours later, the researchers clearly observed a cellular infection and the replication of the monkeypox virus was confirmed in the cells (cytopathogenic effect), with the detection of viral DNA in the culture medium at 48 h , 72 h and 96 h.

So these results show that “Long-term shedding of monkeypox virus DNA can occur in the semen of infected patients within weeks after symptom onset and in semen collected during the acute phase of infection (D + 6 after onset of symptoms) may harbor a virus capable of replication” [capable de se répliquer et donc infectieux].

According to Daniele Lapa, Francesca Colavita and colleagues, the presence of virus particles in semen can be the result of passive diffusion of the virus from blood, urine or genital skin lesions, or the witnessing of virus replication at the level of genitalia. And the researchers added that it remains to be seen if the infectious monkeypox virus found in semen is associated with sperm or if it replicates in the genital tract.

In any case, “The isolation of a replication-competent monkeypox virus from sperm and its prolonged shedding, even at low viral copy number, may indicate the presence of a viral reservoir,” researchers pointed out. Since the patient is infected with HIV, although virologically and immunologically responsive to antiretroviral treatment, it cannot be excluded that the observed prolonged viral shedding is due to immune dysregulation.

The researchers also determined that they found monkeypox virus DNA in 11 of the 14 patients examined. In addition, a viable, replication-competent virus has since been isolated from the seminal fluid of a second HIV+ patient.***.

“In our view, the case we report supports the infection of the monkeypox virus during sexual activity, which can be a viable and recognized route of transmission, especially in the context of the epidemic. in 2022”, conclude the authors, emphasizing that further studies are needed to learn more about the ways of transmission and spread of the virus, especially among people who are not infected with HIV.

It should be noted that most cases of monkeypox (incorrectly called monkeypox) identified in Europe occurred in men who had sex with men. Transmission occurs during close contact of mucous membranes or skin to skin, or through postilions during prolonged face-to-face contact.

Currently, transmission during penetrative sex has been reported in the UK by two men who have not traveled to countries where monkeypox is endemic and where the temporal relationship between sex and the appearance of genital lesions has been established. In addition, monkeypox virus DNA was also found in three Italian patients and two in Germany. Finally, an American study reported the detection of viral DNA in the seminal fluid of 29 patients out of 32 examined.

Mark Gozlan (Follow me on TwitterFacebook, LinkedInand my new blog ‘Diabetes in all states’dedicated to one thousand and one parts of diabetes – seventeen posts.)

* The value of Cq (number of cycles before obtaining a positive PCR reaction signal) is 18.9 in the skin lesion and 21.4 in the scar.

** Cq values ​​are between 27.8 (at D+7) and 40.6 (at D+19). This last Cq value indicates a low level of viral genome copies almost three weeks after the onset of symptoms.

*** Cq = 22.7.

To find out more:

Lapa D, Carletti F, Mazzotta V, and others. Monkeypox virus isolation from a semen sample collected early in the course of infection in a patient with prolonged seminal viral shedding. Lancet Infect Dec 2022; published online August 2.

Noe S Zange S Seilmaier M et al. Clinical and virological features of the first human monkeypox cases in Germany. Infection. 2022; (published online July 11.) doi: 10.1007/s15010-022-01874-z

Thornhill JP, Barkati S, Walmsley S, et al; SHARE-net Clinical Group. Monkeypox Virus Infection in Humans in 16 Countries – April-June 2022. N Engl J Med. 2022 Jul 21. doi: 10.1056/NEJMoa2207323

Heskin J Belfield A Milne C et al. Sexual transmission of monkeypox virus—a new route of infection. J Infected. 2022. Published online June 1. doi: 10.1016/j.jinf.2022.05.028

Antinori A, Mazzotta V, Vita S, and others; INMI Monkeypox Group. Epidemiological, clinical and virological characteristics of four cases of monkeypox supporting transmission through sexual contact, Italy, May 2022. Euro Surveill. 2022 Jun;27(22):2200421. doi: 10.2807/1560-7917.ES.2022.27.22.2200421

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