Monkeypox transmission in heterosexual couples in Nigeria

Simon Collins, HIV i-Base

Although the current global monkeypox (MPX) outbreak is overwhelmingly linked to sexual networks of gay and bisexual men, the possibility of heterosexual transmission was suspected in at least some African countries where MPX is endemic.

Such transmission is now reported in a small series of cases seen at a single clinic in Nigeria, published ahead of peer review, by Dr Dimie Ogoina, who was the lead researcher in the earlier reports. [1, 2]

The paper describes seven adult cases (aged 21 to 42) seen at the Niger Delta University Teaching Hospital (NDUTH), Okolobiri, between June and August 2022. No cases were seen earlier this year.

All cases had 3-6 recent partners and no recent non-sexual exposure risks. Detailed histories connected several cases as couples and contact tracing included at least one partner who had not sought formal medical care. Others initially used unspecified injections from ‘patent medical stores’ rather than seeking care from a sexual health clinic.

Genital lesions were reported in all cases, often with other sites reported. The number of lesions ranged from <10 (n=2) to 80–100 (n=2).

None of the household contacts of these cases reported MPX symptoms.

The authors concluded that sexual transmission could have accounted for MPX cases reported in earlier outbreaks and also that cases are likely to still be underreported.

The paper also highlighted the lack of access to testing, vaccines and treatment in African countries where MPX is endemic, despite cases having a higher risk of complications, including fatalities.


  1. Ogoina D et al. Monkeypox among linked heterosexual casual partners in Bayelsa, Nigeria. Qeios. doi:10.32388/2Z4ZH4.2. (24 August
  2. Ogoina D et al. Clinical Course and Outcome of Human Monkeypox in Nigeria. Clin Infect Dis 2020; 71: e210–e214.

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