According to a study published in the British Medical Journal, people infected with monkeypox during the ongoing global outbreak are showing symptoms not normally associated with viral infections.
The findings are based on 197 confirmed cases of monkeypox at an infectious disease center in London, UK, between May and July 2022.
The researchers said some of the more common symptoms they described included rectal pain and swelling (edema) of the penis, which differed from previous outbreak symptoms.
They recommend that clinicians consider monkeypox infection in patients with these symptoms.
According to the researchers, those with confirmed monkeypox infection who have extensive penile lesions or severe rectal pain should be considered for ongoing evaluation or inpatient management.
All 197 participants in the 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 with lesions on their skin or mucous membranes, usually on the genitals or in the perineal area.
Most (86 percent) patients reported systemic disease (affecting the whole body). The most common systemic symptoms were fever (62 percent), swollen lymph nodes (58 percent), and muscle aches and pains (32 percent).
In contrast to existing case reports suggesting that systemic symptoms precede skin lesions, 38% of patients developed systemic symptoms after the onset of mucosal lesions, whereas 14% presented with lesions without systemic features. .
A total of 71 patients reported rectal pain, 33 sore throat, and 31 penile edema, while 27 had oral lesions, 22 had solitary lesions, and 9 had tonsil swelling.
Solitary lesions and swollen tonsils were not previously recognized as specific features of monkeypox infection, and may be mistaken for other conditions, the researchers noted.
Only one-third (36 percent) of participants also had an HIV infection, and 32 percent of those screened for sexually transmitted infections had a sexually transmitted infection, they said.
Overall, 20 (10 percent) participants were hospitalized for symptom management, most commonly rectal pain and penile swelling.
However, no deaths were reported and no patients required intensive care at the hospital.
Only one participant had recently traveled to an endemic area, confirming ongoing transmission within the UK, and only a quarter of patients had contact with someone with confirmed monkeypox infection, leading to was more likely to be transmitted by people with no or very few symptoms.
The study authors acknowledge some limitations, such as the observational nature of the results, the potential variability of medical record keeping, and the fact that the data are limited to one center.
However, he said the findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay men, bisexuals and other men who have sex with men in the UK and many other non-endemic countries.
“Understanding these findings will have major implications for contact tracing, public health advice, and ongoing infection control and isolation measures,” the researchers added.
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