The COVID‑19 pandemic brought about global awareness to the importance of infectious disease prevention. Yet, other infections, such as mpox (commonly known as monkeypox), have continued to spread, highlighting the challenges in transmission dynamics and clinical management. A study recently conducted in the University Hospital in Kraków, and published in this issue of Polish Archives of Internal Medicine,¹ provides a detailed overview of 45 cases of mpox diagnosed in Poland between June and November 2022, offering a crucial insight into the infection that presents unique challenges in identification, management, and prevention.²

The findings of this study prompt important reflections. According to the authors, the majority of cases occurred among men who have sex with men (MSM), suggesting that sexual contact may be a key factor in the virus transmission.¹ The high proportion of cases in the MSM populations underscores the need for an informed, nonstigmatizing approach toward vulnerable communities, and highlights the importance of developing effective educational and preventive strategies to reduce the incidence and transmission of sexually transmitted infections (STIs).^3,4

Additionally, the high prevalence of coexisting STIs, such as HIV and syphilis, among mpox patients in Kraków, highlights the complexity of managing the overlapping infections. These findings suggest that integrating STI testing and treatment into mpox management protocols could offer broader diagnostic and therapeutic opportunities, especially for at‑risk groups. This synergistic approach, which already includes pre‑exposure prophylaxis (PrEP) for HIV, could positively impact not only mpox control but also the management of other STIs.⁵

The data from the Kraków study not only add to the scientific understanding of mpox epidemiology in nonendemic settings but also underscore the critical importance of vaccination against orthopoxvirus infections, which may offer partial protection against mpox. Although smallpox vaccination programs were discontinued following its eradication, a new generation of vaccines has been developed and approved for use in mpox exposure, offering a potential preventive tool for at‑risk groups.⁶

Mpox is caused by monkeypox virus (MPXV) belonging to the Orthopoxvirus genus, and is characterized mainly by skin eruptions, fever, and lymphadenopathy.⁷ Transmission occurs through direct contact with infected skin lesions or respiratory droplets; however, the current outbreak reflects a new transmission profile, with predominance among MSM.⁸ The Kraków study found that 93% of patients identified themselves as MSM, suggesting a predominantly sexual route of transmission.⁹

Data from a larger cohort monitored in Warsaw support this trend, showing prevalence among MSM, especially those engaging in relationships with multiple partners and at‑risk sexual behaviors.¹⁰ Notably, the association of mpox with other STIs, such as HIV, syphilis, gonorrhea, and chlamydia, is often observed among patients in these groups.¹¹ These associations point to the need for integrated STI screening in at‑risk patients, aligned with global and national recommendations.

The study by Raczyńska et al¹ reflects a clinical profile of mpox observed in other recent outbreaks, marked by mild, self‑limiting symptoms in most patients but complex management in the cases of coinfection and risk factors, such as HIV. Notably, the study reports that most patients experienced polymorphic rash and painful lymphadenopathy, often localized in the inguinal or cervical areas. Skin lesions affected various anatomical areas, including the genitalia, oral cavity, anorectal area, and, to a lesser extent, the hands, feet, and chest. This distribution of lesions reflects the virus site of inoculation and the role of direct contact, predominantly during sexual activity, as a route of transmission.⁹

While patients with mild symptoms, such as skin rashes, fever, and swollen lymph nodes, were primarily treated with supportive care,⁹ those with HIV and low CD4 counts displayed more severe clinical manifestations.¹² Accurate differential diagnosis is crucial, considering conditions such as syphilis, herpes simplex, and lymphogranuloma venereum.

Initially, hospitalization was mandated for all suspected or confirmed mpox cases; however, this requirement was later adapted to allow for more flexible management, with hospitalization reserved for the more severe cases.¹ This adjustment has proven useful for optimizing health care resources and improving organizational efficiency in managing mpox cases.

Prevention is a key element in containing mpox, especially through vaccination. While there is no specific mpox vaccine, smallpox vaccines, such as Modified Vaccinia Ankara (MVA), approved in Europe for mpox prevention in at‑risk groups, are used.¹³ The study by Raczyńska et al¹ showed that only 1 patient had been vaccinated against smallpox, indicating a low vaccination coverage in Poland.¹⁰ Greater vaccine availability could thus better protect vulnerable populations, limiting the virus transmission.

One of the most significant aspects of the study from Kraków¹ is its analysis of at‑risk behaviors. As many as 33% of the patients reported engaging in sexual activity under the influence of drugs, while 29% reported group sex, highlighting the correlation between mpox and high‑risk sexual practices. Additionally, 64% of the patients had a history of previous STIs, indicating increased vulnerability.¹¹ This suggests that preventive strategies must include an educational component, promoting safe sexual practices and the use of barrier protection.

The Kraków study¹ emphasizes the importance of viewing mpox not only as a dermatological condition but also as an infection linked to social and behavioral dynamics. Health policies should therefore include: 1) improved access to vaccines for at‑risk groups¹⁴; 2) regular STI screenings for mpox patients, both for diagnostic and epidemiologic purposes¹⁵; and 3) educational programs on prevention, promoting PrEP and safe sexual practices. Recognizing mpox as a sexually transmitted infection could facilitate a more integrated and targeted approach to limiting its spread.

The mpox outbreak in Poland represents a significant health challenge, with implications for both patients and the entire STI prevention system. The data reported by the University Hospital in Kraków provide a valuable resource for understanding the clinical characteristics and risk factors associated with mpox, contributing to improved screening and prevention practices. Considering mpox as an infection linked to sexual and behavioral dynamics underscores the need for a comprehensive preventive action based on education, vaccines, and support for at‑risk populations.