Self-sampling monkeypox virus testing in high-risk populations, asymptomatic or with unrecognized Mpox, in Spain

Cristina Agustí*, Héctor Martínez-Riveros, Àgueda Hernández-Rodríguez, Cristina Casañ, Yesika Díaz, Lucía Alonso, Elisa Martró, Jordana Muñoz-Basagoiti, Marçal Gallemí, Cinta Folch, Ibrahim Sönmez, Héctor Adell, Marta Villar, Alexia París de León, Sandra Martinez-Puchol, A. C. Pelegrin, Daniel Perez-Zsolt, Dàlia Raïch-Regué, Rubén Mora, Luis VillegasBonaventura Clotet, Nuria Izquierdo-Useros, Pere Joan Cardona, Jordi Casabona

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)


The recent monkeypox virus (MPXV) outbreak was of global concern and has mainly affected gay, bisexual and other men who have sex with men (GBMSM). Here we assess prevalence of MPXV in high-risk populations of GBMSM, trans women (TW) and non-binary people without symptoms or with unrecognized monkeypox (Mpox) symptoms, using a self-sampling strategy. Anal and pharyngeal swabs are tested by MPXV real-time PCR and positive samples are tested for cytopathic effect (CPE) in cell culture. 113 individuals participated in the study, 89 (78.76%) were cis men, 17 (15.04%) were TW. The median age was 35.0 years (IQR: 30.0–43.0), 96 (85.02%) individuals were gay or bisexual and 72 (63.72%) were migrants. Seven participants were MPXV positive (6.19% (95% CI: 1.75%–10.64%)). Five tested positive in pharyngeal swabs, one in anal swab and one in both. Six did not present symptoms recognized as MPXV infection. Three samples were positive for CPE, and showed anti-vaccinia pAb staining by FACS and confocal microscopy. This suggests that unrecognized Mpox cases can shed infectious virus. Restricting testing to individuals reporting Mpox symptoms may not be sufficient to contain outbreaks.

Original languageEnglish
Article number5998
Number of pages11
JournalNature communications
Issue number1
Publication statusPublished - Dec 2023


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