Monkeypox Viral Detection In Semen Specimens of Confirmed Cases: A Systematic Review and Meta-Analysis

Abstract Background The current literature shows increasing concerns about potential seminal transmission of monkeypox virus (MPV). Accordingly, we aimed to understand better the potential presence of MPV in the seminal fluids and others specimens obtained from monkeypox (MPX) cases. Methods On June 26, 2022, a systematic search of the literature was conducted across PubMed, Scopus, Web of Science, EMBASE, ScienceDirect, ProQuest, EBSCOHost-Academic Search Complete, and Google Scholar to find articles that examine the presence of MPV in seminal fluid of confirmed cases . The search was updated on August 12 to include newly published articles. The prevalence of MPV DNA presence in the seminal fluid and other specimens was pooled in a meta-analysis and results were presented as effect sizes and their corresponding 95% confidence intervals (CI). The quality of included articles was assessed using the National Institute of Health tool. Results Eight articles (including 585 MPX-confirmed patients) were included. Only four studies were eligible for a meta-analysis, and the individual positivity rate of MPV DNA in semen specimens ranged from 61.11% to as high as 90.62%, while the pooled rate was 78% (95% CI: 62-93%; I2=61.93%) among 91 examined patients. Moreover, the pooled positive rate of MPV DNA was the highest in rectal samples (100%; 95%CI: 94-100%), followed by urinary (31%; 95%CI: 1-61%), nasopharyngeal (28%; 95%CI: 24-32%), and blood/plasma (8%; 95%CI: 6-10%) samples, respectively. Furthermore, two articles also investigated the infectivity of MPV particles detected in seminal specimens by testing their replication competence. Culturing MPV was successful in one out of three patients included in these studies. Also, based on available evidence, the positivity of MPV in semen specimens can be observed early and up to 19 days after symptoms onset. Conclusions MPV is highly prevalent in seminal specimens of MPX cases, further corroborating the role of sexual transmission of the disease. However, further evidence is still needed to shed more light on the replication competence of these particles.