Thread by @DrJayVarma

Concur with discussion below. Adds to weight of evidence that direct inoculation via receptive intercourse (anal, oral) likely primary route of infection for many patients

Important implications ⬇️

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https://twitter.com/kakape/status/1556774907337478148

Helps explain why >10K cases globally during 2022 outbreak remain tightly connected to gay men & their sexual networks: transmission via anal/oral receptive intercourse far more efficient than other routes.

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Short incubation period and likelihood of direct inoculation supports why pre-exposure #monkeypox vaccination for groups at highest risk likely much more effective at preventing disease than post-exposure vaccination.

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While less sensitive, sampling of OP will still have value for widespread screening (similar to what we do for GC in gay/bi/MSM). Important to study if saliva superior to OP as specimen type.

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The high % of patients with #HIV remains a notable finding across many different countries - and seems consistent as testing has expanded, so less likely to be ascertainment bias. Is HIV an independent risk factor for #monkeypox infection?

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