New study reveals Monkeypox (Mpox) virus may persist at oral and rectal sites after recovery

Medical News: Understanding the Persistence of Monkeypox Virus at Oral and Rectal Sites
In a groundbreaking study led by researchers from Melbourne Sexual Health Centre and Monash University, Australia, new findings shed light on the persistence of monkeypox virus (mpox) at oral and rectal sites even after clinical recovery. This Medical News report delves into the study, providing an easy-to-understand overview for the general public. The research is particularly significant as it highlights potential risks associated with the virus even after patients are considered recovered.


New study reveals Monkeypox (Mpox) virus may persist at oral and rectal sites after recovery

Monkeypox, a viral infection that gained global attention following a significant outbreak in 2022 with the advent of the Clade 2b variant, predominantly affects men who have sex with men (MSM). While many health authorities focused on lesion-based clearance to determine recovery, this study highlights the importance of monitoring other body sites for the presence of the virus.
 
The study covers the key finding, which involved men self-collecting oral and rectal swabs for viral analysis. The research institutions involved include Melbourne Sexual Health Centre, Alfred Health, Monash University, and the Peter Doherty Institute for Infection and Immunity.
 
Research Findings: Persistence Beyond Lesion Resolution
The study enrolled 19 men with suspected monkeypox, all of whom were monitored over time for viral persistence. The participants, recruited from Melbourne Sexual Health Centre, collected their own oral, anal, and urine samples for PCR and viral culture testing. PCR tests detect viral genetic material, while culture tests determine the viability of the virus (i.e., whether it can still infect others). The swabs were taken weekly, starting from their first clinical visit, and continued until all visible lesions had resolved.
 
Out of the 19 participants, 14 (74%) initially tested positive for the virus through oral swabs. Of these, 6 (43%) continued to test positive for monkeypox via oral PCR and viral culture even after their skin lesions had resolved. On average, these men were still testing positive 14.5 days after lesion clearance. It's worth noting that only one of the men had oral lesions when they first visited the clinic.

The situation was similar for anal swabs. Sixteen participants (84%) initially had positive results from anal swabs, with nine (56%) continuing to test positive for viral DNA via PCR. Six of these nine individuals also tested positive for viable virus through culture. This occurred up to 16 days after the skin lesions had healed. Most of the men who had persistent anal positivity (56%) also had anal lesions at the initial visit.
 
For urine samples, four men (25%) tested positive for the virus initially, but only two continued to show viral genetic material after lesion clearance. However, no viable virus was detected through urine cultures at any point.
 
These findings are s ignificant because they indicate that while the skin lesions may clear, the monkeypox virus can still be present at other body sites, potentially posing an ongoing risk of transmission. The study authors suggest that patients should be advised to avoid physical and sexual contact involving oral and anal sites for a longer period after lesion resolution.
 
Implications for Public Health and Transmission
The persistence of the monkeypox virus, particularly in the oral and rectal areas, raises concerns about the current public health recommendations. Typically, patients are cleared once their skin lesions heal, as this is considered the end of their contagious period. However, this study’s data suggests that individuals might still carry and transmit the virus even after being deemed “recovered.”

For example, individuals who tested positive in both oral and anal swabs had no visible signs of infection, which could lead them to believe they are no longer infectious. Public health officials might need to revise their guidelines to include extended periods of caution for patients post-recovery, especially for those engaging in sexual activities.
 
Broader Context and Future Studies
While Australia experienced fewer monkeypox cases compared to the UK, Europe, and North America, the findings from this study provide critical insights that can be applied globally. The authors emphasize the need for further research, particularly studies involving larger sample sizes, to more accurately determine how long the virus persists and remains viable in different body sites after lesion clearance.
 
Additionally, the study highlights the importance of using viral culture methods alongside PCR. PCR alone can detect viral DNA, but it doesn’t confirm whether the virus is still capable of causing infection. By incorporating viral culture, the researchers were able to show that the virus remains viable in a significant number of cases after visible symptoms have subsided.
 
Recommendations for Patients and Healthcare Providers
The researchers recommend that individuals recovering from monkeypox take extra precautions, particularly if they have been diagnosed with oral or anal lesions. Abstaining from physical contact, including sexual activity involving these areas, for a longer period could help prevent further transmission.
 
Healthcare providers should consider extending the follow-up period for monkeypox patients, ensuring that individuals are fully cleared from all potential sites of viral persistence before advising them to resume normal activities.
This study underscores the importance of comprehensive testing and monitoring, particularly for high-risk populations such as MSM. In light of these findings, it is crucial for both healthcare providers and patients to remain cautious, even when external symptoms have resolved.
 
Conclusion
In conclusion, this study provides valuable insights into the persistence of the monkeypox virus at oral and rectal sites after clinical recovery. It raises important questions about current public health guidelines and the potential risks of transmission after skin lesions have cleared. As research continues, public health authorities will need to adapt their recommendations to ensure that individuals are fully cleared of the virus before resuming physical and sexual activity.
 
The study findings were published in the peer-reviewed journal The Lancet Microbe.
https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(22)00382-2/fulltext
 
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