Overview of the main themes and subthemes identified in the narratives of semistructured interviews, supported by illustrative quotes
| Theme | Subtheme | Quote |
| Self-perceived exposure settings and contexts | Gay-oriented festival | “For me, these events [referring to two gay festivals] are all about socialising. And yes, also having sex is part of that for me.” (Participant #1) |
| Cruising venue | “I travelled to Budapest and, you know, I am a single man… I’ve been visiting quite some different bars and [gay] saunas(…)I think [the infection] must have happened there.” (Participant #11) | |
| Home | “I usually meet casual hook-ups from Grindr at my place, or his place, it depends.” (Participant #9) | |
| Unknown (sexual) | “I don’t know [where infection was acquired], but it must have been from a sexual contact. I have been preoccupied with work, and apart from sexual contacts I haven’t been meeting people lately.” (Participant #5) | |
| Unknown (non-sexual) | “I have been puzzled as to where I caught it [monkeypox]. I haven’t had any sexual contact in months!” (Participant #12) | |
| Sexual interactions | Anonymous encounters | “I don’t spend a lot of time with them [sex partners], it’s really just about casual hook-ups(…)When you’ve had some drinks and the lights are dimmed [in the dark room], you don’t really notice much [physical symptoms].” (Participant #8) |
| MPX-suspected symptoms among sex partners | “I noticed a rash on his buttocks, but I didn’t really think much of it. I thought it must have been some pustules or acne or something.” (Participant #4) | |
| Sexual networks of gbMSM | “Me and my partner met a man via Grindr for a sex date at our place. He told us he was from the U.S.A., visiting Belgium to attend (name of gay fetish festival in Antwerp, Belgium).” (Participant #2) | |
| Health-seeking behaviour and risk perception related to MPX | Confusing MPX symptoms for other STIs | “It started with a pustule on my penis. Then I went to my GP because I recognised it as herpes, from previous times.” (Participant #5) |
| Confusing MPX symptoms for other skin conditions | “They [the media] always talked about ‘pox’, in plural, but I only had one lesion that looked like a mosquito bite. How the hell was I supposed to know that was going to be monkeypox?!” (Participant #3) | |
| Risk perception | “I did not think it [MPX] was something I would get … I have always been careful, using condoms, and I am not that adventurous when I go out.” (Participant #5) | |
| “I had heard of it [monkeypox], but never thought I would really catch it.(…)I always thought of it as something not affecting me. They [media] call it a rare disease.” (Participant #3) | ||
| Provider-related diagnostic delay | “He [the GP] thought about Syphilis and did a blood test, but it came back negative. He wanted to test for Syphilis again… I had the feeling he was not really digging deep enough, so I went to an STI clinic instead.” (Participant #10) |
gbMSM, gay and bisexual men having sex with men; GP, general practitioner; MPX, monkeypox.