On June 2 the man, who has not been named, tested positive for Covid-19.
"On the afternoon of the same day a rash started to develop on his left arm," the paper stated.
"The following day small, painful vesicles (blisters) …. with halos appeared on the torso, lower limbs, face and glutes."
After the blisters turned into pustules, the man went to the emergency department at a hospital in Catania.
The man had tested negative to HIV in September 2021 and had been vaccinated against Covid-19 with two doses of the Pfizer jab in the same year. He had contracted Covid in January 2022.
Given the number of lesions on his skin monkeypox was suspected. The test was confirmed positive for both that and Covid.
"This case highlights how monkeypox and Covid-19 symptoms may overlap … hence, clinicians should be aware of the possibility of SARS-CoV-2 and monkeypox virus co-infection" said the paper.
As he had likely acquired monkeypox through sexual intercourse, an HIV test was then performed which also came back positive. The results indicated that he had probably contracted that virus recently as well, most likely in Spain.
HIV is a sexually transmitted infection (STI). Monkeypox is not and is mostly passed through contact with infected rash, scabs or fluids. It can be transmitted through non-sexual contact and even from materials used by someone with monkeypox. However, sex is a successful way for this contact to occur and in the recent outbreak has accounted for most, although not all, cases.
"Our case emphasises that sexual intercourse could be the predominant way of transmission.
"Therefore, complete STI screening is recommended after a diagnosis of monkeypox,"
The man was discharged from hospital on July 11 and isolated at home. Most cases are mild and people make a full recovery.
HIV can be undetectable and untransmissible
The World Health Organisation (WHO) has said that 38.4 million people are living with HIV globally.
HIV is the virus that can lead to AIDS. However, advances in medicine mean that so long as people are on appropriate treatment HIV is a chronic but manageable condition.
With proper treatment, HIV can also be undetectable and untransmissible to others.
People living with HIV who are taking antiretroviral therapy as prescribed and who consequently maintain an undetectable level of the virus in their system are unable to pass on HIV even if they don't use condoms during sex.
People who are HIV negative can also take a treatment known as pre-exposure prophylaxis – or PrEP – which protects them from contracting the virus.
Another treatment, called post-exposure prophylaxis, can help prevent HIV from establishing in someone's system after exposure if that treatment is started quickly.
In Australia, these treatments have led to a 37 per cent decrease in HIV transmission among Australian born gay and bisexual men in six years, according to the Australian Federation of AIDS Organisations.
Monkeypox has been labelled a "public health emergency" by the WHO with 45,000 known cases worldwide. However there have been only a very small number of deaths outside of some parts of Africa where a more lethal variant has spread.
More than half a billion people have contracted Covid-19 with 6.5 million deaths from the virus.
