This is the analysis of 197 cases of monkeypox diagnosed at an infectious disease center in London between May and July 2022. Some of the common symptoms described, including rectal pain and penile swelling (oedema), differ from those documented in previous outbreaks. These new symptoms should therefore raise the suspicion of monkeypox infection and patients diagnosed with monkeypox, presenting with these extensive penile lesions or severe rectal pain should benefit from hospital care.
Isolated lesions and swollen tonsils
- The 197 participants were men, with an average age of 38, of whom 196 identified as gay, bisexual or, more simply, having sex with men.
- all affected participants had lesions on the skin or mucous membranes, most often on the genitals or in the perianal region;
- 86 reported systemic disease (affecting the whole body);
- the most common systemic symptoms were fever (62%), swollen lymph nodes (58%) and muscle aches (32%);
- contrary to existing case reports suggesting that systemic symptoms precede skin lesions, 38% of patients developed systemic symptoms after onset of mucocutaneous lesions, while 14% had lesions without systemic features;
- 71 patients – or more than 1 in 3 affected patients – reported rectal pain, 33 sore throat and 31 penile edema, while 27 had oral lesions, 22 had a solitary lesion and 9 had swollen tonsils ;
- isolated lesions and swollen tonsils were not previously known to be typical of monkeypox infection;
- 36% of participants were also HIV-infected and 32% of those screened for sexually transmitted infections had a sexually transmitted infection;
- 10% of participants were admitted to hospital for management of their symptoms, most commonly rectal pain and penile swelling;
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no deaths were reported and no patient required intensive care unit management.
What mode of contamination? Only one participant had recently traveled to an endemic area and approximately 25% had been in contact with someone with confirmed monkeypox. According to the authors, these data confirm :
“unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men, with major implications for contact tracing, public health recommendations, and enforcement. implementation of infection control and isolation measures.