TY - JOUR T1 - Understanding sexual transmission dynamics and transmission contexts of monkeypox virus: a mixed-methods study of the early outbreak in Belgium (May-June 2022). JF - Sex Transm Infect Y1 - 2022 A1 - Jef Vanhamel A1 - Valeska Laisnez A1 - Laurens Liesenborghs A1 - Isabel Brosius A1 - Nicole Berens-Riha A1 - Thibaut Vanbaelen A1 - Chris Kenyon A1 - Koen Vercauteren A1 - Laga, Marie A1 - Hammami, Naïma A1 - Oriane Lambricht A1 - Romain Mahieu A1 - Amaryl Lecompte A1 - Wim Vanden Berghe A1 - Vuylsteke, Bea KW - monkeypox KW - Sexual Behavior AB -

OBJECTIVE: The available epidemiological and clinical evidence from the currently ongoing monkeypox (MPX) outbreak in non-endemic areas suggests an important factor of sexual transmission. However, limited information on the behaviour and experiences of individuals with an MPX infection has to date been provided. We aimed to describe the initial phase of the MPX outbreak in Belgium, and to provide a more in-depth description of sexual behaviour and transmission contexts.

METHODS: We used routine national surveillance data of 139 confirmed MPX cases with date of symptom onset until 19 June 2022, complemented with 12 semistructured interviews conducted with a subsample of these cases.

RESULTS: Sexualised environments, including large festivals and cruising venues for gay men, were the suspected exposure setting for the majority of the cases in the early outbreak phase. In-depth narratives of sexual behaviour support the hypothesis of MPX transmission through close physical contact during sex. Despite awareness of the ongoing MPX outbreak, low self-perceived risk of MPX acquisition and confusing initial signs and symptoms for other STIs or skin conditions delayed early detection of an MPX infection. In addition, we describe relevant contextual factors beyond individual behaviour, related to sexual networks, interpersonal interactions and health systems. Some of these factors may complicate early MPX detection and control efforts.

CONCLUSION: Our results highlight the role of sexual contact and networks in the transmission of MPX during the early phase of the outbreak in Belgium. Risk communication messages should consistently and transparently state the predominant sexual transmission potential of MPX virus, and prevention and control measures must be adapted to reflect multilevel factors contributing to MPX transmission risk.

M3 - 10.1136/sextrans-2022-055601 ER -