Background

In 2015, the UN General Assembly announced its 2030 Sustainable Development Goals, including the WHO’s aims to achieve a 90% decrease in STIs and to end the epidemic of neglected tropical diseases.1 In 2022, reports emerged regarding the sexual transmission of one such neglected tropical disease, mpox (monkeypox). Within weeks, a global outbreak was confirmed.

First described in 1958 in a colony of research monkeys in a Copenhagen laboratory, the symptoms of this new ‘mpox’ orthopoxvirus were phenotypically similar to the variola virus disease, smallpox. By 1970, the first documented case of zoonotic transmission was recorded in a 9-month-old child in the formerly named Zaire, and thus reports of human mpox entered the medical literature. It is almost certain that mpox was circulating long before its European discovery, in endemic regions of West and Central Africa, and it was not until the global eradication campaign against smallpox that the two conditions were distinguished.

Since its discovery, two viral clades of mpox distinct in geography, genetics and symptom severity have resulted in multiple infections, predominantly on the outskirts of tropical forests. This has led to the hypothesis that while no animal reservoir has been identified, rodents hunted for bushmeat are the primary host.2

Epidemiological studies in the region, including WHO surveillance programmes from 1970 to 1986, found 404 cases, predominantly in children.3 With the end of active surveillance in 1986, recorded cases dropped off to 13 over the next 10 years.2 4 Epidemiologists concluded that, given the low transmission rate, mpox was unlikely to sustain itself in the human population. Dwindling international support for epidemiological monitoring, in combination with a paucity of access to laboratory facilities and testing across the regions, meant that sporadic cases could not be proven, and further understanding of the virus, its symptomatic …