A higher prevalence of genital and anal skin lesions and lower fatigue and fever were seen among new monkeypox patients than among those infected during previous outbreaks of the virus, according to a study published in The Lancet Infectious Diseases .
To date, more than 5,000 cases of monkeypox have been reported from 51 countries around the world that are not endemic for the disease, according to the US Centers for Disease Control and Prevention. The number of infections in Europe accounts for around 90 percent of the global total, with the UK reporting 1,235 cases – the highest on the continent.
Researchers from Chelsea & Westminster Hospital NHS Foundation Trust looked at 54 patients who attended four sexual health clinics in London and were diagnosed with monkeypox during a 12-day period in May 2022.
Of the 54 patients, all but two of the patients did not know that they had been in contact with a known case, and none reported travel to sub-Saharan Africa but had very recently visited other European countries.
All patients identified as men who had sex with men, and 47 of 52 reported at least one new sexual partner in the three weeks before symptoms, and 49 of 52 reported inconsistent condom use during the same time period.
More than half of the patients had more than five sexual partners in the 12 weeks before monkeypox diagnosis.
All patients were symptomatic and had skin lesions – 94% of patients had at least one genital or perianal skin lesion. Most patients had mild illness and recovered while isolated at home, but five individuals required hospitalization due to pain or infection of the skin lesions.
All improved and were discharged a median of seven days from hospital admission.
“The commonly observed symptom of anal and penile skin lesions and the fact that a quarter of patients tested positive for gonorrhea or chlamydia at the same time as monkeypox infection suggest that transmission of monkeypox virus in this cohort is emerging.” from close skin-to-skin contact, for example in the context of sexual activity,” said Dr Ruth Byrne from the Trust.
She added that “it is possible that at various stages of infection, monkeypox may mimic common STIs, such as herpes and syphilis, in its presentation. It is important that sexual health clinicians and patients are familiar with the symptoms of monkeypox, as misdiagnosis of the infection may prevent appropriate intervention and prevention of further transmission.
The study also observed important differences in the clinical characteristics of this cohort compared with previous cases reported from earlier outbreaks in other countries.
Fewer patients in this cohort reported feeling weak and tired and/or had a fever than in case studies of previous outbreaks.
In addition, 18 percent (10/54) of patients in this cohort did not report any early symptoms before the appearance of skin lesions.
“Given the proposed route of infection through contact during sexual activity and the number of clinical findings that differ from previous descriptions, we suggest that case definitions that currently describe symptoms as acute illness with fever be revised to are best adapted to the current findings, as at least one in six of this cohort would not meet the current definition of a ‘probable case’, said the Trust’s Dr Niccolo Girometti.
The researchers also predict that the high prevalence of genital skin lesions in patients and the high rate of concomitant sexually transmitted infections means that sexual health clinics are likely to see additional cases of monkeypox in the future.
However, the team cautioned that their findings may not be representative of the overall outbreak. They said it is important to remain alert to the possibility of spread to other groups while balancing targeted health promotion to groups disproportionately affected by the current epidemic.
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