The mpox illness is increasingly spreading in Berlin through sexual activity between men and women. Berlin’s Health and Social Affairs Department, known as Lageso, has recently reported several cases connected to sex-positive events for heterosexual and queer communities, according to the latest weekly report from Lageso (PDF).
In August, Lageso documented two women with mpox. During the same period, a man also reported that he might have contracted the virus through sex with a woman. All three cases are believed to have arisen from anonymous sexual encounters in clubs or at home.
Significantly more cases than in some prior years
So far this year, Lageso has reported four mpox infections among women. In general, mpox tends to affect men who have sex with men and who often change sexual partners.
The total number of mpox cases reported in Berlin this year stands at 156. That is more than the prior year (144) and well above the totals for 2024 (38) or 2023 (13).
Across Germany, according to the Robert Koch Institute (RKI), 375 mpox cases have been reported so far this year (as of Aug. 27). Ninety-eight percent of those were men, epidemiologist Klaus Jansen of the RKI told the news agency. Among men with known routes of infection, nearly all had acquired mpox through sex with other men. “Nationwide, we are not currently seeing a development like the one described for Berlin by Lageso,” he noted. It remains to be seen how the situation will unfold.
“This is a cause for great concern”
Infection epidemiologist Claudia Ruscher of Lageso said, “It is a major cause for concern that mpox is advancing into a group of people who had not been affected before and who are therefore less vaccinated and less informed.”
Four women initially seemed to be outliers, but there is now a new dynamic at play. Infections have appeared within a short period. In recent years there had been either no cases or only one woman per year. Only during the major outbreak in 2022 were there four female cases in total. At that time, however, the total number of cases in the outbreak was roughly ten times higher than today.
What are the risks? People who are unvaccinated and contracting mpox for the first time tend to have a more severe illness. “They more often experience fever and widespread skin lesions,” Ruscher explained. “It’s not just blisters; there can also be itchy, sometimes pus-filled pustules. Those are very painful.”
Mpox is transmitted through close physical contact
Mpox is a viral infection transmitted through close contact, especially during sexual activity. The risk of infection is highest when contacting the characteristic skin changes (blisters or scabs) that can appear all over the body. Condoms do not provide sufficient protection. Droplet transmission via saliva is also possible. There is a vaccine available.
In 2022, the disease spread particularly rapidly in Germany, especially among sexually active gay men. This prompted a targeted vaccination campaign for that group, and vaccine uptake was high.
Razors, bites, or herpes?
Other groups, however, often do not even know mpox exists. If they become infected and develop pustules, they may not immediately connect it to mpox. “Instead, they might think it’s razor burn, mosquito bites, or herpes and may delay seeking medical care.” One patient visited four different doctors before receiving an accurate diagnosis.
How does the scientist view the likely trajectory? “We should anticipate additional infections among women, but it’s hard to estimate the scale.”
The Standing Vaccination Commission (STIKO) recommends mpox vaccination for, among others, men, transgender people, and non-binary people who have sex with men and frequently change partners, as well as sex workers and people who come into contact with infected individuals. The vaccine is highly effective and well tolerated, according to Jansen of the RKI. Those who become infected despite vaccination typically experience a milder illness.
