UK Man contracted MonkeyPox without any sexual contact

We report human monkeypox in a man who returned to the United States from the United Kingdom and reported no sexual contact. He had vesicular and pustular skin lesions but no anogenital involvement. The potential modes of transmission may have implications for the risk of spread and for epidemic control.

The 2022 multicountry monkeypox outbreak has been linked primarily to intimate contact among men who have sex with men (1,2). We describe a case of monkeypox in a traveler who returned from the United Kingdom to the United States who did not report recent sexual contact.

A man in his 20s sought care at an emergency department in Stanford, California, USA, on day 7 of an asynchronous, diffuse vesicular rash following travel to the United Kingdom. The first lesion appeared ≈14 days after he attended a large, crowded outdoor event at which he had close contact with others, including close dancing, for a few hours. He said that many attendees were in sleeveless tops and shorts. He wore pants and a short-sleeved top. He did not notice any skin lesions on anyone present, nor did he notice anyone who seemed sick. He shared an e-cigarette with a woman that he met while there. The event was not a rave and was not attended specifically or mostly by persons identifying as gay or bisexual. He attended other similar outdoor events over 4 days. He reported consuming alcohol but no other drug use at these events. He did not wear a mask at these events. He had contact with domestic dogs that he petted.

He took 2 flights to return to the United States; masks were worn on 1 flight. He identifies as bisexual but reported no recent sexual contacts during his travels or in the preceding 3 months. He reported no close indoor activities, although he traveled on crowded public trains. He reported no close contacts since his return. He lives with 1 roommate who did not manifest any symptoms. He had a history of syphilis treated 3 months earlier and was taking HIV preexposure prophylaxis. He denied preceding fevers, chills, headache, lymph node swelling, cough, fatigue, or anorectal pain.