New clinical symptoms identified in largest international case series of confirmed monkeypox cases QMUL nejm
We describe a human monkeypox case series that includes 528 infections from four WHO regions and 16 countries reported over a 2-month period. Sexual activity, largely among gay or bisexual men, was by far the most frequently suspected route of transmission. The strong likelihood of sexual transmission was supported by the findings of primary genital, anal, and oral mucosal lesions, which may represent the inoculation site.
In our series, the diagnosis of monkeypox was most commonly confirmed from swab specimens taken from skin or genital lesions, with throat or nasopharyngeal swab specimens and blood less commonly tested. Anal or rectal swabs should be considered for those presenting with anal pain or proctitis. A small percentage of persons received antiviral therapy, most often with cidofovir or tecovirimat. Data on the effectiveness of these compounds in humans are limited, although studies in animals and case reports suggest that they may be active.In this case series, 56 persons were older than 50 years of age, and overall, 9% reported having previously received a smallpox vaccination, so we cannot comment on its effect.
Although the current outbreak is disproportionately affecting gay or bisexual men and other men who have sex with men, monkeypox is no more a “gay disease” than it is an “African disease.” It can affect anyone. We identified nine heterosexual men with monkeypox. We urge vigilance when examining unusual acute rashes in any person, especially when rashes are combined with systemic symptoms, to avoid missing diagnoses in heterosexual persons.
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