The Evolving Monkeypox Outbreak Amongst Homosexual and Bisexual Transmission: A Systematic Review


  • Hanny Nilasari University of Indonesia
  • Monica Trifitriana Sriwijaya University
  • Ratrisha Anadya Padjadjaran University
  • Levina Ameline Diponegoro University
  • Dian Pratiwi Bogor Agricultural Institute


Monkeypox, Homosexuals, MSM, STI, Systematic review


Background: Monkeypox is a viral zoonotic disease. It has evolved into human-to-human transmissionwith similar characteristics to smallpox. In contrast with the previous endemic outbreak, this 2022multinational outbreak found numerous data of different skin lesions, predilections and populations. Furthermore, recent findings regarding monkeypox revealed the possibility of sexual transmission. Objective:   As a basis for future monkeypox diagnosis guidelines, providing comprehensive data on the symptoms, predilections, age at presentation, previous history of sexual activities, comorbidities, range of incubation period from the time of sexual activity until the symptoms occured, as criteria for diagnosis of sexual transmitted disease. Method: We performed a comprehensive search on a topic that assesses the outbreak of monkeypoxdisease in 2022 regarding the route of transmission from inception up until September 2022. Result: There were 1310 patients from 10 studies who had monkeypox disease in 2022. Patients were mostly found in European countries, with averaging in their 30s, and were 99,54 % male. Vesiculopustular lesions and ulcers with central umbilication appeared prior to prodromal signs were characteristic.Approximately 90% were transmitted during sexual intercourse and in homosexual group (MSM / Menwho have sex with men), and 5-10% between bisexuals. Approximately 40,84% cases also had HIV as a comorbid disease and 15,42% have concurrent or history of sexually transmitted infection (STI) includingsyphilis, gonorrhea, chlamydia, herpes simplex, mixed, and other STIs. Conclusion: Homosexual and bisexual populations are the most high risk populations in the 2022 outbreak of monkeypox disease. The epidemiology, clinical manifestation, and type of skin lesion were different from the previous outbreak. The findings in this review may supplement information to furtherestablish clinical guidelines on the new presentation of monkeypox disease. Further large-scale studies are necessary to further describe and verify the data with higher levels of evidence.

Author Biographies

Hanny Nilasari, University of Indonesia

Department Dermatology and Venereology, Faculty of Medicine University of Indonesia

Ratrisha Anadya, Padjadjaran University

Faculty of Medicine, Padjadjaran University, West Java, Indonesia

Levina Ameline, Diponegoro University

Faculty of Medicine, Diponegoro University, Central Java, Indonesia

Dian Pratiwi, Bogor Agricultural Institute

Faculty of Animal Biomedical Sciences, Bogor Agricultural Institute, Indonesia


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How to Cite

Nilasari H, Trifitriana M, Anadya R, Ameline L, Pratiwi D. The Evolving Monkeypox Outbreak Amongst Homosexual and Bisexual Transmission: A Systematic Review. J Pak Assoc Dermatol [Internet]. 2024May6 [cited 2024May22];34(1):243-54. Available from:



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