Monkeypox: Newly recognized sexual transmission - A comprehensive and detailed review

Mpox, formerly known as monkeypox, has transformed from a primarily animal-borne infection into a significant public health concern centered within human sexual networks. Historically, most mpox cases resulted from zoonotic transmission, humans becoming infected through direct contact with infected animals or their bodily fluids. However, since 2022, mpox’s epidemiology has shifted dramatically. The infection is now spreading predominantly through close, intimate human interactions, especially sexual contact. Recent global outbreaks highlight this evolution: clusters of cases appear in sexual networks, with a marked rise among men who have sex with men and a predominance of genital and mucosal symptoms. This new reality challenges previous assumptions about mpox, blurring the line between a classic zoonosis and a sexually transmitted infection. In this review, we will examine the scientific evidence behind mpox’s shift toward sexual transmission, discuss the emerging hurdles in clinical recognition and management, and explore the broader implications for sexual health, public health messaging, and future outbreak preparedness.