- The first patient to have covid-19, monkeypox and HIV at the same time was recently diagnosed in Italy.
- He developed a fever and sore throat, then blistering, about a week after a trip to Spain.
- The man had unprotected sex with other men while on vacation, adding to growing evidence of sexual transmission.
A man who tested positive for COVID-19 got a result later that day. Tests showed he also had monkey pox and HIV, according to a case study in the Journal of Infection.
The 36-year-old patient, who was not named in the report, is the first in the world to test positive for all three infections in one day, the researchers said.
The Italian man reported that nine days after returning from a trip to Spain, he developed a fever, sore throat and headache. He tested positive for COVID-19 on July 2 — and his symptoms escalated beyond the typical presentation of the virus within hours.
First, the man noticed a rash on his left arm. The next day, small, painful blisters appeared on his face, trunk, legs and back. As the blisters continued to spread and turn into telltale pustules, the man decided to seek emergency care at a hospital in Catania, Italy.
On July 6 – just a few days after his first symptoms – the man was diagnosed with co-infection with COVID-19, monkey pox and human immunodeficiency virus (HIV). His case shows how early symptoms of monkeypox and COVID can overlap, underscoring the importance of testing for other sexually transmitted diseases after a monkeypox diagnosis, doctors wrote in the report.
‘Suggestive’ skin lesions and recent travels
The man’s body was littered with lesions resembling monkey pox at various stages of progression when he arrived at the hospital. Pustules on the palm of his hand and the side of his foot bulged with pus and were red hot. Other sores had turned into scabs with depressed centers – one of the telltale signs of the virus.
The lesions also affected the patient’s perianal area, which was typical in the recent outbreak. Experts suspect a chance of monkey pox sexual transmission because the outbreak mainly affects men who have sex with men in their intimate region.
Because the patient revealed that he had had unprotected sex with other men during his vacation to Spain, doctors tested him for monkey pox and ordered a full STI panel upon his admission to the hospital. According to his medical history, the man also had syphilis in 2019 and was negative for HIV as of his last test in September 2021.
It’s likely that his HIV infection was fairly recent, based on his sexual history and immune markers that appeared normal.
This particular case “emphasizes that sexual intercourse may be the primary mode of transmission” of monkeypox, doctors wrote in the report.
The man received treatment for COVID and HIV
Since this is the first known co-infection of COVID-19, monkeypox and HIV, doctors are not yet sure how the trio of viruses could affect a patient’s condition.
The Italian patient recovered well, with almost all of his monkeypox lesions after a few days in the hospital. He was given an IV of Sotrovimab, a monoclonal antibody therapy, to treat his COVID infection and improved the next day.
By day six at the hospital, most of the man’s symptoms had disappeared. Pap smears for COVID and monkey pox were still positive, but he had no new skin lesions and was sent to home isolation.
When he returned for a follow-up visit, the patient’s sores were “almost completely healed, leaving a small scar.” He didn’t need treatment for monkeypox, although some doctors may recommend antivirals (namely, tecovirimat or TPOXX) for people with compromised immune systems.
The patient was given combination antiretroviral therapy to maintain his immune system and lower the amount of HIV in his bloodstream. Like many others living with HIV, he will need to continue taking the medication to keep the disease at bay.