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      The relationship between age and sex partner counts during the mpox outbreak in the UK, 2022

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          Abstract

          Background

          Understanding the dynamics of an infectious disease outbreak linked to sexual activity requires valid expectations of likely counts of unique sex partners during the infectious period. Typically, age is the key demographic trait linked to expected partner count, with many transmission models removing adults from the sexually active pool abruptly at a pre-specified age threshold. Modelling the rate of decline in partner counts with age would benefit from a better description of empirical evidence.

          Methods

          During the 2022 mpox epidemic in the UK, we asked individuals about their partner counts in the preceding three weeks, which is about the same as usual infectious period for persons with active mpox. We used negative binomial regression (all responses) and Weibull regression (non-zero responses) to analyse the relationship between age and partner counts, adjusted for other demographic data (such as education level and occupation), sub-dividing by three types of respondent: men who have sex with men (MSM), men who have sex with women, and women who have sex with men.

          Results

          Most respondents had zero or one recent partner, all distributions were skewed. There was a relatively linear declining relationship between age and partner counts for heterosexual partnership groups, but a peak in partner counts and concurrency for MSMs in middle age years (age 35–54), especially for MSM who seemed to be in a highly sexually active subgroup.

          Conclusion

          Useful data were collected that can be used to describe sex partner counts during the British mpox epidemic and that show distinctive partner count relationships with age, dependent on partnership type.

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          Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)

          Catherine Mercer, Clare Tanton, Philip Prah … (2013)
          Summary Background Sexual behaviour and relationships are key components of wellbeing and are affected by social norms, attitudes, and health. We present data on sexual behaviours and attitudes in Britain (England, Scotland, and Wales) from the three National Surveys of Sexual Attitudes and Lifestyles (Natsal). Methods We used a multistage, clustered, and stratified probability sample design. Within each of the 1727 sampled postcode sectors for Natsal-3, 30 or 36 addresses were randomly selected and then assigned to interviewers. To oversample individuals aged 16–34 years, we randomly allocated addresses to either the core sample (in which individuals aged 16–74 years were eligible) or the boost sample (in which only individuals aged 16–34 years were eligible). Interviewers visited all sampled addresses between Sept 6, 2010, and Aug 31, 2012, and randomly selected one eligible individual from each household to be invited to participate. Participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interview. We analysed data from this survey, weighted to account for unequal selection probabilities and non-response to correct for differences in sex, age group, and region according to 2011 Census figures. We then compared data from participants aged 16–44 years from Natsal-1 (1990–91), Natsal-2 (1999–2001), and Natsal-3. Findings Interviews were completed with 15 162 participants (6293 men, 8869 women) from 26 274 eligible addresses (57·7%). 82·1% (95% CI 81·0–83·1%) of men and 77·7% (76·7–78·7%) of women reported at least one sexual partner of the opposite sex in the past year. The proportion generally decreased with age, as did the range of sexual practices with partners of the opposite sex, especially in women. The increased sexual activity and diversity reported in Natsal-2 in individuals aged 16–44 years when compared with Natsal-1 has generally been sustained in Natsal-3, but in men has generally not risen further. However, in women, the number of male sexual partners over the lifetime (age-adjusted odds ratio 1·18, 95% CI 1·08–1·28), proportion reporting ever having had a sexual experience with genital contact with another woman (1·69, 1·43–2·00), and proportion reporting at least one female sexual partner in the past 5 years (2·00, 1·59–2·51) increased in Natsal-3 compared with Natsal-2. While reported number of occasions of heterosexual intercourse in the past 4 weeks had reduced since Natsal-2, we recorded an expansion of heterosexual repertoires—particularly in oral and anal sex—over time. Acceptance of same-sex partnerships and intolerance of non-exclusivity in marriage increased in men and women in Natsal-3. Interpretation Sexual lifestyles in Britain have changed substantially in the past 60 years, with changes in behaviour seeming greater in women than men. The continuation of sexual activity into later life—albeit reduced in range and frequency—emphasises that attention to sexual health and wellbeing is needed throughout the life course. Funding Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.
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            Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis

            Nicolò Girometti, Ruth L. Byrne, Margherita Bracchi … (2022)
            Background Historically, human monkeypox virus cases in the UK have been limited to imported infections from west Africa. Currently, the UK and several other countries are reporting a rapid increase in monkeypox cases among individuals attending sexual health clinics, with no apparent epidemiological links to endemic areas. We describe demographic and clinical characteristics of patients diagnosed with human monkeypox virus attending a sexual health centre. Methods In this observational analysis, we considered patients with confirmed monkeypox virus infection via PCR detection attending open-access sexual health clinics in London, UK, between May 14 and May 25, 2022. We report hospital admissions and concurrent sexually transmitted infection (STI) proportions, and describe our local response within the first 2 weeks of the outbreak. Findings Monkeypox virus infection was confirmed in 54 individuals, all identifying as men who have sex with men (MSM), with a median age of 41 years (IQR 34–45). 38 (70%) of 54 individuals were White, 26 (48%) were born in the UK, and 13 (24%) were living with HIV. 36 (67%) of 54 individuals reported fatigue or lethargy, 31 (57%) reported fever, and ten (18%) had no prodromal symptoms. All patients presented with skin lesions, of which 51 (94%) were anogenital. 37 (89%) of 54 individuals had skin lesions affecting more than one anatomical site and four (7%) had oropharyngeal lesions. 30 (55%) of 54 individuals had lymphadenopathy. One in four patients had a concurrent STI. Five (9%) of 54 individuals required admission to hospital, mainly due to pain or localised bacterial cellulitis requiring antibiotic intervention or analgesia. We recorded no fatal outcomes. Interpretation Autochthonous community monkeypox virus transmission is currently observed among MSM in the UK. We found a high proportion of concomitant STIs and frequent anogenital symptoms, suggesting transmissibility through local inoculation during close skin-to-skin or mucosal contact, during sexual activity. Additional resources are required to support sexual health and other specialist services in managing this condition. A review of the case definition and better understanding of viral transmission routes are needed to shape infection control policies, education and prevention strategies, and contact tracing. Funding None.
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              What Drives the US and Peruvian HIV Epidemics in Men Who Have Sex with Men (MSM)?

              Steven Goodreau, Nicole B. Carnegie, Eric Vittinghoff … (2012)
              In this work, we estimate the proportions of transmissions occurring in main vs. casual partnerships, and by the sexual role, infection stage, and testing and treatment history of the infected partner, for men who have sex with men (MSM) in the US and Peru. We use dynamic, stochastic models based in exponential random graph models (ERGMs), obtaining inputs from multiple large-scale MSM surveys. Parallel main partnership and casual sexual networks are simulated. Each man is characterized by age, race, circumcision status, sexual role behavior, and propensity for unprotected anal intercourse (UAI); his history is modeled from entry into the adult population, with potential transitions including HIV infection, detection, treatment, AIDS diagnosis, and death. We implemented two model variants differing in assumptions about acute infectiousness, and assessed sensitivity to other key inputs. Our two models suggested that only 4–5% (Model 1) or 22–29% (Model 2) of HIV transmission results from contacts with acute-stage partners; the plurality (80–81% and 49%, respectively) stem from chronic-stage partners and the remainder (14–16% and 27–35%, respectively) from AIDS-stage partners. Similar proportions of infections stem from partners whose infection is undiagnosed (24–31%), diagnosed but untreated (36–46%), and currently being treated (30–36%). Roughly one-third of infections (32–39%) occur within main partnerships. Results by country were qualitatively similar, despite key behavioral differences; one exception was that transmission from the receptive to insertive partner appears more important in Peru (34%) than the US (21%). The broad balance in transmission contexts suggests that education about risk, careful assessment, pre-exposure prophylaxis, more frequent testing, earlier treatment, and risk-reduction, disclosure, and adherence counseling may all contribute substantially to reducing the HIV incidence among MSM in the US and Peru.
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                Author and article information

                Contributors
                Julii Brainard:
                ORCID: https://orcid.org/0000-0002-5272-7995
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Louise E. Smith:
                ORCID: https://orcid.org/0000-0002-1277-2564
                Role: Data curationRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Henry W. W. Potts:
                ORCID: https://orcid.org/0000-0002-6200-8804
                Role: ValidationRole: Writing – review & editing
                G. James Rubin: Role: Funding acquisitionRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Soham Bandyopadhyay: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLOS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 8 September 2023
                Publication date Collection: 2023
                Volume: 18
                Issue: 9
                Electronic Location Identifier: e0291001
                Affiliations
                [1 ] Norwich Medical School, University of East Anglia Norwich, Norwich, United Kingdom
                [2 ] Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
                [3 ] Institute of Health Informatics, University College London, London, United Kingdom
                University of Oxford, UNITED KINGDOM
                Author notes

                Competing Interests: HWWP has a PhD student who works at and has fees paid by AstraZeneca. This does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors declare that we have no conflict of interest.

                Author information
                https://orcid.org/0000-0002-5272-7995
                https://orcid.org/0000-0002-1277-2564
                https://orcid.org/0000-0002-6200-8804
                Article
                Publisher ID: PONE-D-23-04595
                DOI: 10.1371/journal.pone.0291001
                PMC ID: 10490899
                PubMed ID: 37682827
                SO-VID: ca4d3038-a80d-403d-9c4a-a18fe34dbd92
                Copyright statement: © 2023 Brainard et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 16 February 2023
                Date accepted : 19 August 2023
                Page count
                Figures: 1, Tables: 5, Pages: 15
                Product
                Funding
                Funded by: National Institute for Health and Care Research (NIHR)
                The study was funded by the National Institute for Health and Care Research (NIHR). This work was funded by the National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, a partnership between the UK Health Security Agency (UKHSA), King’s College London (KCL) and the University of East Anglia (UEA). The views expressed are those of the authors and not necessarily those of the NIHR, UKHSA, Department of Health and Social Care, UEA, KCL, or University College London (UCL). For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: People and Places
                Subject: Population Groupings
                Subject: Sexuality Groupings
                Subject: Men WHO Have Sex with Men
                Subject: Physical Sciences
                Subject: Mathematics
                Subject: Algebra
                Subject: Polynomials
                Subject: Binomials
                Subject: Research and Analysis Methods
                Subject: Research Design
                Subject: Survey Research
                Subject: Surveys
                Subject: Social Sciences
                Subject: Sociology
                Subject: Communications
                Subject: Social Communication
                Subject: Social Media
                Subject: Computer and Information Sciences
                Subject: Network Analysis
                Subject: Social Networks
                Subject: Social Media
                Subject: Social Sciences
                Subject: Sociology
                Subject: Social Networks
                Subject: Social Media
                Subject: Research and Analysis Methods
                Subject: Research Design
                Subject: Survey Research
                Subject: Medicine and Health Sciences
                Subject: Epidemiology
                Subject: Infectious Disease Epidemiology
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Infectious Diseases
                Subject: Infectious Disease Epidemiology
                Subject: People and Places
                Subject: Population Groupings
                Subject: Sexuality Groupings
                Subject: Heterosexuals
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Gender Identity
                Subject: Social Sciences
                Subject: Psychology
                Subject: Gender Identity
                Custom metadata
                Data Availability All relevant data are located at https://osf.io/ad7yj/.

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