Researchers have found that some people with monkeypox are not presenting with typical symptoms, and their disease could look more like a typical STI.
A study looking at people diagnosed recently sound that ‘many’ of those infected have only single genital lesions, or they have sores within the mouth or in the anus.
The standard symptoms for monkeypox include sores and scabs across the body.
‘In some people, anal and oral symptoms have led to people being admitted to hospital for management of pain and difficulties swallowing,’ they said.
‘This is why it’s so important that these new clinical symptoms be recognized and healthcare professionals be educated on how to identify and manage the disease – misdiagnosis can slow detection and thus hinder efforts to control the spread of the virus.’
There have now been 2,050 confirmed monkeypox cases across England so far with the majority based in London.
At-risk people hare now eligible to get the vaccine on the NHS, including men who have sex with men, frontline medical staff at greatest risk of exposure, and those who have been in close contact with a confirmed case.
Last weekend, clinics in London delivered over 1,000 vaccinations.
The new study looked at 528 confirmed infections at 43 sites globally between 27 April and 24 June 2022.
At the moment, the disease is disproportionately affecting men who have sex with men, with 98% of people in this group.
But the researchers warned that although sex was the most likely way these patients picked up the virus, it can be transmitted ‘by any close physical contact through large respiratory droplets and potentially through clothing and other surfaces’.
They warned that it’s very important to be able to correctly identify monkeypox because there is a global shortage of both vaccines and treatments.
‘Recognising the disease, contact tracing and advising people to isolate will be key components of the public health response,’ they said.
Professor Chloe Orkin, who led the study, said: ‘Viruses know no borders and monkeypox infections have now been described in 70 countries and in more than 13,000 people.
‘We have shown that the current international case definitions need to be expanded to add symptoms that are not currently included, such as sores in the mouth, on the anal mucosa and single ulcers.
‘These particular symptoms can be severe and have led to hospital admissions so it is important to make a diagnosis. Expanding the case definition will help doctors more easily recognize the infection and so prevent people from passing it on.’
Dr John Thornhill, who works treating sexual health issues and is the first author on the study, said: ‘While we expected various skin problems and rashes, we also found that one in ten people had only a single skin lesion in the genital area, and 15 percent had anal and/or rectal pain.
‘These different presentations highlight that monkeypox infections could be missed or easily confused with common sexually transmitted infections such as syphilis or herpes. We therefore suggest broadening the current case definitions.
‘We have also found monkeypox virus in a large proportion of the semen samples tested from people with monkeypox. However, this may be incidental as we do not know that it is present at a high enough levels to facilitate sexual transmission. More work is needed to understand this better.’
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