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Retrospective testing for mpox virus in routine STI screens from men who have sex with men in England, August–October 2022
  1. Rachel Pitt-Kendall1,
  2. Clare Foster1,
  3. Michael Rayment2,
  4. Beata Orzechowska1,
  5. Rufat Mammadov1,
  6. Suneeta Soni3,
  7. Simon Mortlock4,
  8. Jodie Owen5,
  9. Luke Uglow4,
  10. Michaela Joanne Day1,
  11. Rupa Rai Gurung1,
  12. Amber Savary-Trathen3,
  13. Rhian Jenkins3,
  14. Emma McGuire1,
  15. Natalie Gordon4,
  16. Sara Louise Day6,
  17. Adrian M Kelly7,
  18. Charlotte Goward4,
  19. Kate Folkard1,
  20. Hannah Charles1,
  21. Hamish Mohammed1,
  22. Colin S Brown1,
  23. Helen Fifer1
  1. 1 UK Health Security Agency, London, UK
  2. 2 Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  3. 3 University Hospitals Sussex NHS Foundation Trust, Brighton, UK
  4. 4 Preventx Limited, Sheffield, UK
  5. 5 UK Health Security Agency - Porton, Salisbury, UK
  6. 6 Chelsea and Westminster Healthcare NHS Trust, London, UK
  7. 7 Lead Commissioner Sexual Health e-Service, City of London Corporation, London, UK
  1. Correspondence to Dr Rachel Pitt-Kendall, UK Health Security Agency, London, SE1 8UG, UK; Rachel.Pitt{at}


Objectives A global outbreak of mpox (monkeypox) has been ongoing since 2022, with most cases in the UK detected in gay, bisexual and other men who have sex with men (GBMSM). Asymptomatic and pauci-symptomatic mpox infection has been reported outside of the UK. We aimed to investigate whether mpox could be detected in specimens from GBMSM in England who were attending sexual health services (SHSs) for asymptomatic sexually transmitted infection screening.

Methods Anonymised, residual clinical specimens from GBMSM undertaking routine asymptomatic screening for gonorrhoea (Neisseria gonorrhoeae (NG)) and chlamydia (Chlamydia trachomatis (CT)) infection were tested for the presence of mpox virus. Specimens were collected between 1 August and 7 October 2022 from three SHSs in high-mpox incidence areas in England. Testing was performed using a dual-clade, mpox virus-specific real-time PCR.

Results During the collection period, 2927 clinical specimens (951 pharyngeal swabs, 1022 urine specimens and 954 rectal swabs) were obtained from 1159 GBMSM. Mpox virus was detected in four specimens from two participants who attended the same SHS at different times (the first during the week 8–12 of August, the second during the week 19–23 of September). One participant was positive in the urine specimen only, while the other tested positive at all three sites.

Conclusions A very low prevalence (2 of 1159, 0.17%) of mpox infection was detected in GBMSM attending SHS in England for asymptomatic NG/CT screening, suggesting that undetected infection in this population was unlikely to be a main driver of transmission. Confirmed mpox cases in the UK declined from over 1100 per month in June and July to 764 cumulatively during the collection period. These data give reassurance that the observed reduction in cases during the collection period was not due to undetected infection or changes in presentation among SHS attendees. Currently, there is insufficient evidence to support routine testing of asymptomatic GBMSM for mpox infection in England.

  • Homosexuality, Male

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  • Handling editor Miłosz Parczewski

  • Twitter @mikeyrayment, @suneeta_soni_, @cstewartb

  • Contributors HF, CSB, RPK, MR, SS, SM, NG, SLD, AMK and CG conceived the study. RPK, BO, RM, JO, MJD and RRG co-ordinated and performed laboratory work and collated the results. MR, SS, SM, LU, AS-T, RJ and NG facilitated the specimen referral. CF, EM, KF, HC and HM provided expert advice. RPK, CF, HF and CSB drafted the manuscript. All authors reviewed and commented on the manuscript.

  • Funding This work was supported by a research grant from the Medical Research Council (MR/X018563/1).

  • Competing interests None declared.

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