A study published in The BMJ identifies important differences in monkeypox symptoms between the current outbreak and previous outbreaks in endemic regions. The findings are based on 197 confirmed cases of monkeypox at an infectious disease center in London between May and July 2022.
Some of the common symptoms they describe, including rectal pain and penile swelling (edema), differ from those described in previous outbreaks.
As such, the researchers recommend that doctors consider monkeypox infection in patients who present with these symptoms. And they say those with confirmed monkeypox infection with extensive penile lesions or severe rectal pain “should be considered for ongoing review or hospital treatment.”
According to government data, as of July 18, 2022, there were 2,137 confirmed cases of monkeypox in the UK. Of these, 2,050 were in England and almost three quarters (73%) were in London. The 197 participants in this study were men (average age 38 years), of whom 196 identified as gay, bisexual, or other men who have sex with men.
All patients presented lesions on the skin or mucous membranes, most commonly on the genitals or perianal area. The majority (86%) of patients reported systemic (affecting the entire body) disease. The most common systemic symptoms were fever (62%), swollen lymph nodes (58%), and muscle aches and pains (32%).
And in contrast to existing case reports suggesting that systemic symptoms precede cutaneous lesions, 38% of patients developed systemic symptoms after the onset of mucocutaneous lesions, while 14% presented lesions without systemic features.
A total of 71 patients reported rectal pain, 33 had sore throat, and 31 had penile edema, while 27 had oral lesions, 22 had a solitary lesion, and 9 had swollen tonsils.
The authors note that solitary lesions and swollen tonsils were not previously known as typical features of monkeypox infection and could be confused with other conditions.
Just over a third (36%) of participants also had HIV infection and 32% of those screened for sexually transmitted infections had a sexually transmitted infection.
Overall, 20 (10%) of participants were hospitalized for treatment of symptoms, most commonly rectal pain and penile swelling. However, no deaths were reported and no patients required intensive care in hospital.
Only one participant had recently traveled to an endemic region, confirming ongoing transmission within the UK, and only a quarter of patients had had known contact with someone with confirmed monkeypox infection, raising the possibility. of transmission by people without or with very few symptoms.
The authors acknowledge some limitations , such as the observational nature of the findings, the potential variability of clinical record-keeping, and the fact that the data are limited to a single center.
However, they say these findings confirm the unprecedented ongoing community transmission of monkeypox virus among gay, bisexual and other men who have sex with men seen in the United Kingdom and many other non-endemic countries.
They write: "Understanding these findings will have important implications for contact tracing, public health advice, and ongoing isolation and infection control measures." And they demand continued research to inform isolation and infection control policies and guide the development of new diagnostics, treatments and preventive measures.
Conclusions These findings confirm the unprecedented ongoing community transmission of monkeypox virus among gay, bisexual and other men who have sex with men observed in the United Kingdom and many other non-endemic countries. A variable temporal association between mucocutaneous and systemic features was observed, suggesting a new clinical course of the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile edema. These presentations should be included in public health messages to aid early diagnosis and reduce subsequent transmission. |
