Background and objective:
In June 2022, the first case of Monkeypox (MPX) was recorded in the Province of Padua. The behavioral and clinical characteristics of MPX cases obtained through epidemiological investigations and contact tracing performed by the Public Health Hygiene Service (SISP) of the Health Local Unit Euganea are described.

Methods:
In the observational study, cases with PCR confirmation and contacts identified between 6th June and 19th September 2022 have been considered.

Results:
Monkeypox virus infection was confirmed in 26 individuals, 92% of them were identified as men who have sex with men (MSM). The mean age was 37 years. The estimated incubation period was 8 days (95%CI:7-10). 5 cases was epidemiologically linked to case 0 (excluded from the study), a Spanish tourist. 5 cases were imported from Spain or UK. 15 patients (55%) were autochthonous, but only 4 with epidemiological link. 13 patients (50%) met the index case through dating apps, 6 in MSM clubs. 77% of patients (n.20) declared multiple/anonymous sexual activity, of these the mean of high-risk contacts per patient is 0.45. Prodromal symptoms were detected in 50% of cases. All cases (n.26) presented skin lesions, of which 92% anogenital and 50% hand/forearm. Lymphadenopathy was detected in 62% of cases. The mean time between the first symptoms and the diagnostic confirmation was 6 days (95%CI:4-7), the recovery was 21 days (95% CI: 17-26).

Conclusion:
The MPX outbreak in the Padua MSM community reflected the international epidemiology. The high proportion of anogenital lesions confirm the MPXV transmissibility during sexual activity. The time delay between prodromal symptoms and diagnosis can be attributed to their non-specificity. Skin lesions were being the main factor in accessing the Infectious Diseases department. Stigma and fear of media exposure may reduce contact tracing compliance, particularly in patients who report intense risky sexual activity.