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Egocentric sexual network analysis among gay and bisexual men who have sex with men with and without mpox infection
  1. İbrahim Sönmez1,2,
  2. Héctor Martínez Riveros1,3,
  3. Cinta Folch1,4,
  4. Clara Suñer5,
  5. Yesika Díaz6,
  6. Lucía Alonso1,5,
  7. Cristina Agusti4,7,
  8. Adrià Mendoza8,9,
  9. Eloy José Tarín-Vicente10,
  10. Xènia Oller5,
  11. Andrea Alemany5,
  12. Àngel Rivero9,10,
  13. Eva Orviz11,
  14. Ana Silva-Klug12,
  15. Oriol Mitjà5,
  16. Jordi Casabona1,4
  17. MOVIE-CC Study Group
    1. 1 CEEISCAT, Badalona, Spain
    2. 2 IGTP, Badalona, Spain
    3. 3 Department of Pediatrics, Universidad Autónoma de Barcelona, Barcelona, Spain
    4. 4 CIBERESP, Madrid, Spain
    5. 5 Fundació Lluita Contra la Sida, Badalona, Spain
    6. 6 Department of Health, Barcelona, Spain
    7. 7 Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT)-Public Health Agency of Catalonia (ASPC), Badalona, Spain
    8. 8 Hospital Can Ruti, Badalona, Spain
    9. 9 Checkpoint Barcelona, Barcelona, Spain
    10. 10 Hospital Universitario 12 de Octubre, Madrid, Spain
    11. 11 Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
    12. 12 Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
    1. Correspondence to Dr Cinta Folch, CEEISCAT, Badalona, Catalunya, Spain; cfolch{at}


    Objectives Recent outbreaks of the mpox (monkeypox) virus have been detected in dense sexual networks of gay and bisexual men who have sex with men (GBMSM). The objective of this study is to describe and compare the epidemiological and behavioural characteristics, as well as the sexual networks, of GBMSM diagnosed with mild mpox in Spain.

    Methods A prospective case–control study was conducted in Spain from July 2022 to February 2023. The study targeted a key population of GBMSM aged 18 years or older. Study participants were categorised into cases, those who were diagnosed with mpox virus infection; and controls, those who were not diagnosed. We examined and compared the sexual network characteristics of the two groups—mpox-positive (mpox-P) and mpox-negative (mpox-N) egos—using χ2, t-test and Wilcoxon test to examine the differences between the two groups in each section. Finally, we conducted univariable and multivariable logistic regressions to determine the factors associated with mpox infection.

    Results Among the 105 participants, 35 (33.3%) were mpox-P. Compared with mpox-N, mpox-P respondents more frequently reported syphilis (mpox-P: 31.4%; mpox-N: 12.9%) and HIV (mpox-P: 45.7%; mpox-N: 18.6%), and mpox-P individuals to have had at least one sexual contact with a confirmed mpox case (mpox-P: 62.5%; mpox-N: 8.3%). In the egocentric network analysis, mpox-P respondents had a higher prevalence of group sex with alters (mpox-P: 18.5%; mpox-N: 8.9%) and one-time sexual partners (mpox-P: 46.1%; mpox-N: 31.7%). Multivariable logistic regressions showed that reporting stranger/client ties (adjusted OR (aOR)=10.3, 95% CI 1.39 to 76.6) with alters, being vaccinated for mpox (aOR=0.07, 95% CI 0.02 to 0.24) and tie strength heterogeneity (aOR=0.01, 95% CI 0.00 to 0.42) were associated with mpox infection.

    Conclusions Our findings highlight the role of demographic, epidemiological and sexual network characteristics in the transmission of mpox virus during the outbreak in Spain. These findings have important implications for future prevention efforts.

    • Epidemiology

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

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    • Handling editor Adam Huw Bourne

    • Twitter @hectorgranota

    • Collaborators MOVIE-CC Study Group: Rafael Muñoz; Silvia Gómez; Maria Ubals; Pep Coll; José Miguel Cabrera; Martí Vall-Mayans; Manuel Agud-Dios; Elena Gil-Cruz; Vira Buhiichyk; Roger Paredes; Nuria Prat; Bonaventure Clotet; Pablo L. Ortiz-romero; Maria-Rosa Sala Farre; Josep Maria Bonet-Símo; Ramona Hervas Perez; Yolanda Maltas Hidalgo; Michael Marks.

    • Contributors All authors contributed sufficiently to be eligible for being an author.

      The guarantor and the first author, İbrahim Sönmez, accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding This research was supported by CIBER (Strategic Action for Monkeypox) (Consorcio Centro de Investigación Biomédica en Red; CB 2021), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea - NextGenerationEU.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.