The cohort comprised 62 trans women, 69 cis women, and five non-binary individuals (who were, because of small numbers, grouped with cis women to form a category of people assigned female at birth for the purpose of comparison).
Conclusion: The name of the study being called 'Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series' is grossly misleading. Why on earth lump them together at all? Indeed read on...
121 (89%) of 136 individuals reported sex with men.
So this is a study largely comparing heterosexual women with gay males. So its not representative of women and men in the general population. Its representative of women who are lower risk and gay males who are higher risk.
37 (27%) of all individuals were living with HIV, with a higher proportion among trans women (31 [50%] of 62) than among cis women and non-binary individuals (six [8%] of 74).
Wow. Whats going on here? What is the instance of HIV in the general population? Those transwomen are particularly high risk even if you allow for them being gay. That really suggest there is a behavioural pattern here - transwomen do not have the same health risks as women and their sexual behaviour is much higher risk (and is unrepresentative of the general male population too). They are mixing in higher risk groups. However women who do get monkey pox, look to also be in a higher risk group for sexual behaviour than the general population. This is the key finding of the study. The people they are studying have sexual behaviour which is riskier than others.
Sexual transmission was suspected in 55 (89%) trans women (with the remainder having an unknown route of transmission) and 45 (61%) cis women and non-binary individuals; non-sexual routes of transmission (including household and occupational exposures) were reported only in cis women and non-binary individuals.
Hello! What's going on here??? What are the transwomen doing that they seemingly don't recall / remember??? Sexual transmission is much higher in this group of males than women to begin with, with the rest having no idea how they got it, and not reporting it as non-sexual. The women however were clearly getting it off someone else due to other close contact which the transwomen clearly weren't also party to - so caring, someone they lived with or through work of some kind. Which suggests their living arrangement and occupations were also markedly different.
And here's the paragraph that says this:
Although 121 (89%) of the 136 individuals in this global case series reported having sex with men, 59% of cis women and non-binary individuals had a regular male partner, whereas 73% of trans women had multiple male partners. Having multiple sexual partners was a common risk factor for monkeypox virus infection in previous series in men. Sexual contact was thought to be the most likely route of transmission in 74% of our cohort overall. This value is lower than the 95–100% reported in series of men.
Except they failed to identify a single alternative route of transmission in the males in the study, but they did for the females... This is one of those 'it depends on how you write this up' rather than proving anything. Absence of evidence, isn't evidence of absence.
25 (34%) of 74 cis women and non-binary individuals submitted to the case series were initially misdiagnosed.
Women were failed and were misdiagnosed.
And interestingly this is why:
Most trans women (41 [66%]) presented to sexual health or HIV clinics, and 13 (21%) presented to emergency departments. Cis women and non-binary individuals most commonly presented to emergency departments (26 [35%]), with 21 (24%) presenting to sexual health or HIV clinics and the remainder presenting to other hospital departments (including dermatology, gynaecology, and obstetrics) or primary care (table 2). Misdiagnosis before a diagnosis of monkeypox virus infection was more common among cis women and non-binary individuals (25 [34%]) than among trans women (six [10%]). Additionally, delayed diagnosis was more common among cis women and non-binary individuals, with 48 (77%) trans women diagnosed on their first visit compared with 43 (58%) cis women and non-binary individuals
The men knew they were high risk and behaving in a high risk way and the HCPs identified them as men who were at high risk for monkeypox. Women got second rate treatment.
Transmissions during the global outbreaks have been overwhelmingly associated with sexual contact and have almost exclusively affected sexually active gay, bisexual, and other men who have sex with men (GBMSM). 28–47% of individuals diagnosed with monkeypox infection are living with HIV, and a majority of those without HIV are on HIV pre-exposure prophylaxis (PrEP). Consequently, international case definitions specify GBMSM as the at-risk group, and prevention efforts have focused on GBMSM on PrEP, individuals living with HIV, men with sexually transmitted infections (STIs), and individuals attending sex-on-site venues, including sexual activity at mass gatherings. So far, sustained spread outside of GBMSM networks has not occurred; however, the spread of monkeypox virus to women is a concern, especially because of the potential for serious consequences for fetuses if pregnant individuals become infected.
Well the study hasn't disproved any of this. Nor has it gone anywhere near anything to do with pregancy really.
We hypothesised that the transmission routes and clinical presentation of monkeypox virus in the current outbreaks might not be the same for women as for GBMSM, and that presentations might also differ between cis and trans women.
We hypothesised that women are women and that transwomen who have sex with men will have exactly the same risk profiles for sexually transmitted diseases that are well known and documented, because transwomen are behaving in sexually different ways, mixing in high risk groups and well, aren't women. And we have successfully proved in a study that women are not the same as transwomen.
34 (55%) of 62 trans women and two (3%) of 74 cis women and non-binary people reported current sex work.
So we are comparing trans sex workers with women. The women weren't getting it from sex work. BIG question there for how the women were getting infected. What were their male partners doing? This question is massively important.
Plus look at this:
Although 121 (89%) of the 136 individuals in this global case series reported having sex with men, 59% of cis women and non-binary individuals had a regular male partner, whereas 73% of trans women had multiple male partners.
19 (14%) individuals (18 cis women and one non-binary individual) had children at home, among whom two children subsequently contracted monkeypox.
Women have children who they are responsible for. Shocker.
White males 8/62 (13%) women 32/74 (43%) overall 40/136 (29%)
Latinx males 38/62 (61%) women 23/74 (31%) overall 61/136 (45%)
Black males 13/62 (21%) women 15/74 (20%) overall 28/136 (21%)
Asian males 2/62 (3%) women 1/74 (1%) overall 3/136 (2%)
Mixed males 1/62 (2%) women 1/74 (1%) overall 2/136 (1%)
Whats going on here?
Trans and latin is particularly high risk. This is massively different to the white breakdown.
Admitted to hospital for monkeypox virus infection
males: Yes 2/62 (3%) women: 15/74 (20%)
Hmmm. If you read further on the range of what they were hospitalised for there is a marked difference with there being a much wider range for women.
17 (13%) of 136 women (including 15 [20%] cis women and non-binary individuals and two [3%] trans women) were hospitalised. Reasons for admission included cellulitis, abscess, or bacterial superinfection; severe anorectal pain; odynophagia; infection control purposes; ocular lesion; and altered mental status and worsening left-sided weakness.
The males were ONLY admitted for anorectal pain or 'other' reasons (not detailed above).
Further to that Women were also much less likely to get anti-biotic treatment or monkey-pox specific treatment.
Furthermore, most epidemiological surveillance datasets have not distinguished between cis and trans women, thereby prohibiting a detailed description and characterisation of any differences in these two subpopulations, which are generally under-represented and under-reported in HIV and sexual health research.
Uh huh what?! Are we saying that its typical and usual for women to be lumped together with high risk behavioured transwomen in studies? And given that they are massively going to much more likely to be sex workers than women, is that fucking up what little research there is in HIV and sexual health research for women? And is this saying that an EVEN GREATER number of cases of HIV and STIs are actually in males than women than research is suggesting? What is this saying about the behaviour of males and how it differs from females?
Conclusion
Latin transwomen, are particularly at risk. Transwomen were more likely to have multiple partners, be sex workers and have HIV to begin with. They couldn't identify transmission routes which weren't sexual. They got monkeypox specific treatments and were diagnosed quicker.
Women were much more likely to have lower risk lifestyles as they had fewer sexual partners and were much less likely to be sex workers. They were higher risk than the general population, but lower risk than males engaging in sex with men. There was a risk in normal occupations or cohabiting separate from sexual transmission which hasn't be identified in males. They got a far wider range of complications and were much more likely to be hospitalised. This possibly is the result of later diagnosis, less medical intervention through antibiotics and lowe access to treatment which wasn't specific to monkeypox. There is a big unanswered question about the lifestyles of their male partners.
So even though the transwomen were more vulnerable they were getting better and quicker treatment than women. The transwomen were being identified as male, knew they were male and were well aware that they were at greater risk due to where they were showing up for help.
The study shows in great detail why lumping transwomen together with women, isn't good for women as there is a difference in behaviour, lifestyles, risk profiles, outcomes and access to appropriate care.
For me, its an interesting study with a bloody dreadful title. And it shows exactly WHY sex matters and why gender is a load of old male baloney. It would be much better merely to record lifestyle data and sex without the confusing word salad, which can easily misrepresent data for actual women.