Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain

Start date: May 2022

End date: June 2022

Detailed information regarding the epidemiology and the clinical features of Monkeypox in the 2022 outbreak is scarce. In this study, we aimed to comprehensively evaluate the epidemiology, clinical features, and virological features of patients diagnosed with Monkeypox at three large hospitals in Spain. Participants were offered lesion, anal, and oropharynx swabs for PCR testing. Participant data were collected by means of interviews conducted by dermatologists or specialists in sexually transmitted infections and were recorded using a standard case report form. Outcomes assessed in all participants with a confirmed diagnosis were demographics, smallpox vaccination, HIV status, exposure to someone with Monkeypox, travel, mass gathering attendance, risk factors for sexually transmitted infections, sexual behaviour, signs and symptoms on first presentation, virological results at multiple body sites, co-infection with other sexually transmitted pathogens, and clinical outcomes 14 days after the initial presentation.


181 patients with Monkeypox were assessed at the three participating centres during the study period, all of whom consented to take part in the study (99 at Hospital Universitario 12 de Octubre, 67 at BCN Checkpoint, and 15 at Drassanes). 175 (97%) of 181 participants were male and six (3%) were female. The median age of the participants was 37·0 years. 72 (40%) participants were HIV-positive, 71 (99%) of whom were on antiretroviral therapy. No individuals were identified without any potential sexual exposures, and travel to endemic regions was not reported by any participant.