There is a body of evidence documenting the detection of RNA and DNA viruses in semen after acute infection. Monkeypox DNA has been detected in semen up to day 11 after acute infection in men in Italy, although longitudinal sampling was not performed after this point.
It is unclear whether this is due to seminal transport, since the testes are immunologically protected sites (as occurs with other viral infections such as Ebola virus disease), or to resolution of meatal or urethral lesions that disappear as they progress. resolve skin lesions.
However, in light of this, current UKHSA advice takes a cautious approach and recommends that men who have had a confirmed or highly probable diagnosis of monkeypox according to the UKHSA case definition should use condoms during sexual intercourse. for 12 weeks after complete recovery from monkeypox infection. This is in line with advice from the World Health Organization (WHO).
It must be recognized that there is currently no evidence to support this or any other alternative advice.
After the initial 12 weeks and up to 6 months after recovery from infection, the UKHSA recommends performing monkeypox PCR on semen samples (and, where necessary, oropharyngeal and/or rectal swabs) if the patient:
are undergoing fertility treatment or planning a pregnancy are undergoing planned semen banking (for example, prior to chemotherapy) have an immunocompromised sexual partner (including a pregnant partner) are concerned about transmission to sexual partner(s) by any other reason and request a test from your doctor
Testing can also be offered at the request of the patient after discussion with the local genitourinary/infection team and then with the Rare and Imported Pathogens Laboratory (RIPL).
A single negative PCR after 12 weeks post-recovery is considered adequate, with the recognition that this is based on expert opinion in the absence of a clear evidence base.
It should also be noted that a positive PCR does not necessarily indicate that the patient is potentially infectious, only that DNA fragments have been detected. However, since viral culture is not feasible for clearance testing, if the PCR is positive, it is prudent to consider the patient potentially infectious.
Thereafter, repeat samples should be submitted every 2 weeks and the patient should continue to use condoms until a negative test result is obtained.
Samples submitted without a minimum 2-week run interval will not be processed without prior consultation with RIPL.
Any proof that is requested sooner than 12 weeks after retrieval must first be discussed and agreed with RIPL prior to shipment. Samples received without discussion will not be processed. For semen tested prior to 12 weeks post retrieval, 2 samples collected at least 48 hours apart must be tested, and both must be negative to be considered clear.
Specimen collection must take place at a facility capable of arranging transportation of a Category B specimen. These are typically monkeypox hospitals and not genitourinary medicine (GUM) clinics.
Specimens must be shipped in a universal sterile container and shipped to:
High containment microbiology
FAO Marian Killip / Matthew Jones
UKHSA Colindale
61 Colindale Avenue
London
NW9 5EQ
Samples must be packaged and shipped as a Category B infectious substance. Make sure samples are properly packaged and sealed. Leaking samples will not be processed. Samples will only be tested during business hours Monday through Friday.
Appropriate advice from clinicians should include that this is an unvalidated diagnostic test.
Evidence is expected to emerge over the duration of detection of monkeypox DNA in semen, allowing this guidance to be updated, and earlier tests may be offered if supported by evidence.
Source: www.gov.uk