2022年5月至11月期间，全球报告了7.8万多人暴发人类猴痘病毒感染，主要是男男性行为者。我们描述了猴痘病毒感染的流行病学和临床特征，在顺性别(cis)和跨性别(trans)妇女和非二元个体中指定出生性别为女性，以提高识别和了解危险因素。

报告了15个国家在2022年5月11日至10月4日期间共136例猴痘病毒感染者的数据。在纳入病例系列研究的74名cis女性和非二元个体中，有25名(34%)最初被误诊。134人中有124人(93%)出现皮疹，129人中有95人(74%)出现肛门生殖器皮疹，121人中有105人(87%)出现水泡脓疱性皮疹。中位病灶数为10个(IQR 5 ~ 24;范围1 - 200)。在获得数据的119例患者中，65例(55%)发生了涉及阴道、肛门、口咽或眼的黏膜病变。阴道和肛交与这些部位的病变相关。14份阴道拭子标本中均检测到猴痘病毒DNA。17例(13%)患者住院治疗，主要原因是病变的细菌重叠感染和疼痛管理。33人(24%)接受了tecovirimat治疗，6人(4%)接受了暴露后疫苗接种。

女性和非二元个体猴痘的临床特征与男性相似，包括存在肛门和生殖器病变，并有明显的粘膜受累。解剖学上，肛门生殖器病变反映了性行为:外阴阴道病变在顺性女性和非二元性个体中占主导地位，肛门直肠特征在变性女性中占主导地位。队列中HIV合并感染的流行率很高。

Abstract

Background: Between 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.

Methods: International 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.

Findings: Collaborators 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.

Interpretation: The 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.

文章连接：

www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02187-0/fulltext

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