Is My Patient at Risk for Monkeypox?

August 23, 2022

Written by Joseph Miller

Spoon Feed
The current monkeypox outbreak is characterized by sexual transmission and presents with a flu-like prodrome followed by characteristic rash.

Why does this matter?
Monkeypox is spreading rapidly. We covered this earlier, but things change as we learn more. We need to know about this previously rare disease.

Zoonosis or sexually transmissible? Yes

Cases
This article is a case series from an international HIV research collaborative that characterizes the current outbreak. Traditionally, monkeypox is known to spread through droplets and contact with lesions. These data reveal an emerging pattern of possible sexual transmission, mostly through men who engage in sex with men, and correlation of spread in those with HIV infection who traveled to endemic areas and participated in large sexual gatherings.

Presentation
The initial presentation of monkeypox was variable, usually as a non-specific flu-like prodrome followed by rash, with symptom onset at a median of 7 days post-exposure. Early presentations may be confused with COVID, though lymphadenopathy was present in 56% of patients, distinguishing the disease process. Notably, some cases presented as isolated genital or perianal lesions, and at least one case was initially misdiagnosed as syphilis. Skin lesions were the most common symptom, appearing as umbilicated papules reminiscent of smallpox, and a high percentage were anal and mucosal surface lesions. Anal lesions were usually intensely painful and the most common reason for hospitalization.

Wrapping Up
These data suggest monkeypox is sexually transmissible, though a clear exposure history was not available in most cases. It also underscores the need to obtain a detailed social history from our patients. Don’t mistake this as a disease limited only to MSM, as anyone in close contact with the rash or respiratory secretions is susceptible. Finally, note the study’s risk for selection bias, given this was a convenience sample selected from an HIV research group.

Peer reviewed by Dr. Ketan Patel

Another Spoonful
You need to read the CDC summary about monkeypox.

Source
Monkeypox Virus Infection in Humans across 16 Countries – April-June 2022. N Engl J Med. 2022 Jul 21. doi: 10.1056/NEJMoa2207323. Online ahead of print.