Possible Exposures Among Mpox Patients Without Reported Male-to-Male Sexual Contact

Six U.S. Jurisdictions, November 1-December 14, 2022

J. Danielle Sharpe, PhD; Kelly Charniga, PhD; Katrina M. Byrd, MD; Ruth Stefanos, MD; Linda Lewis, DVM; Jessica Watson, MD; Amanda Feldpausch, DVM; Jessica Pavlick, DrPH; Julie Hand, MSPH; Theresa Sokol, MPH; Emma Ortega, MPHTM; Preeti Pathela, DrPH; Robin R. Hennessy, MPH; Melissa Dulcey, DVM, PhD; Lisa McHugh, PhD; Michael Pietrowski, MPH; Dana Perella, MPH; Seema Shah, MD; Azarnoush Maroufi, MPH; Melanie Taylor, MD; Anna Cope, PhD; Ermias D. Belay, MD; Sascha Ellington, PhD; Andrea M. McCollum, PhD; Leah Zilversmit Pao, PhD; Sarah Anne J. Guagliardo, PhD; Patrick Dawson, PhD


Morbidity and Mortality Weekly Report. 2023;72(35):944-948. 

In This Article

Abstract and Introduction


The extent to which the 2022 mpox outbreak has affected persons without a recent history of male-to-male sexual contact (MMSC) is not well understood. During November 1–December 14, 2022, CDC partnered with six jurisdictional health departments to characterize possible exposures among mpox patients aged ≥18 years who did not report MMSC during the 3 weeks preceding symptom onset. Among 52 patients included in the analysis, 14 (27%) had a known exposure to a person with mpox, including sexual activity and other close intimate contact (eight) and household contact (six). Among 38 (73%) patients with no known exposure to a person with mpox, self-reported activities before illness onset included sexual activity and other close intimate contact (17; 45%), close face-to-face contact (14; 37%), attending large social gatherings (11; 29%), and being in occupational settings involving close skin-to-skin contact (10; 26%). These findings suggest that sexual activity remains an important route of mpox exposure among patients who do not report MMSC.


During infectious disease outbreaks, there are often cases for which a source of infection cannot be identified. The 2022 mpox outbreak disproportionately affected adult gay, bisexual, and other men who have sex with men; however, approximately 30% of U.S. mpox patients did not report male-to-male sexual contact (MMSC).[1,2] During May–October 2022, increases in mpox cases among persons with missing exposure data or no reported MMSC highlighted a need to understand the extent to which the outbreak has affected other populations, as well as additional potential routes of Monkeypox virus (MPXV) transmission, to aid in the development and implementation of public health prevention guidance.[1]

MMSC is defined as cisgender male-to-cisgender male sexual (e.g., oral or anal sex) or intimate contact (e.g., cuddling, kissing, touching partner's genitals or anus, or sharing sex toys) within 3 weeks of symptom onset.