An Italian man has become the first in the world to test positive for COVID-19, monkeypox and HIV all on the same day.

The unidentified 36-year-old first developed a fever, sore throat and headaches nine days after returning from a trip to Spain where he had unprotected sex with other men, according to a case study in the Journal of Infection.

He first tested positive for COVID-19 on July 2 — then within hours started getting a rash and “small, painful” blisters around his body, legs, face and butt, the study said.

Unidentified Italian patient's blisters.
The unidentified man went to an ER after getting “small, painful” blisters over his body after trip to Spain where he had unprotected sex with other men.
Journal of Infection

He went to an ER, and on the second day there again tested positive for COVID-19 — as well as monkeypox.

That same day, July 6, he also learned that he had HIV, despite being negative when he last tested, in September, the study said.

Timeline of Italian man's case study.
The researchers’ timeline shows that he tested positive for COVID, monkeypox and HIV all on the same day, July 6.
Journal of Infection

“As this is the only reported case of monkeypox virus, SARS-CoV-2 and HIV co-infection, there is still not enough evidence supporting that this combination may aggravate [a] patient’s condition,” they wrote.

The researchers said that the “case emphasizes that sexual intercourse could be the predominant way of transmission” of monkeypox.

“Therefore, complete [sexually transmitted infection] screening is recommended after a diagnosis of monkeypox.

“In fact, our patient tested positive for HIV-1 and, given his preserved CD4 count, we could assume that the infection was relatively recent,” they noted of the patient, who previously also had syphilis.

While it is the first known case of its kind, more will likely follow given the rapid spread of monkeypox, with more than 45,000 cases reported in 98 countries.

“The majority of cases were registered in gay or bisexual men often suffering from other” STI, they noted.

“As these pathogens continue to spread, individuals can be simultaneously infected with monkeypox virus, SARS-CoV-2 and STI, making it difficult for physicians to perform the correct diagnosis,” they said, noting how many share similar symptoms.

“Healthcare systems must be aware of this eventuality, promoting appropriate diagnostic tests in high-risk subjects, which are essential to containment as there is no widely available treatment,” they wrote.


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