London: People infected with monkeypox during the ongoing global outbreak are showing symptoms not usually associated with the viral infection, according to a study published in the British Medical Journal.
The findings are based on 197 confirmed cases of monkeypox at an infectious disease center in London, UK between May and July 2022.
The common symptoms they described include rectal pain and penile swelling (edema), which differs from those described in previous outbreaks, the researchers said.
They recommend that doctors consider monkeypox infection in patients with these symptoms.
According to the researchers, individuals with confirmed monkeypox infection with extensive penile lesions or severe rectal pain “should be considered for ongoing evaluation or hospitalization.
All 197 study participants were men (mean age 38 years), of whom 196 identified as gay, bisexual or other men who have sex with men.
All patients presented with lesions on the skin or mucous membranes, most commonly on the genitals or perianal area.
Most (86 percent) of patients reported systemic diseases (affecting the entire 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 percent of patients developed systemic symptoms after the onset of mucocutaneous lesions, while 14 percent had lesions with no systemic features.
A total of 71 patients reported rectal pain, 33 sore throat, and 31 penile edema, while 27 had oral lesions, 22 had a single lesion, and 9 had swollen tonsils.
The researchers noted that solitary lesions and swollen tonsils were not previously known to be typical features of monkeypox infection and could be confused with other conditions.
Just over a third (36 percent) of the participants also had HIV infection and 32 percent of those screened for STIs had a STI, they said.
Overall, 20 (10 percent) of the participants were hospitalized for treatment of symptoms, most commonly rectal pain and penile swelling. However, no deaths were reported and no patient required intensive hospital care.
Only one participant had recently traveled to an endemic region, confirming ongoing transmission within the UK, and only a quarter of the patients had been in contact with someone with confirmed monkeypox infection, raising the possibility of transmission from those with no or very few symptoms.
The study authors acknowledge some limitations, such as the observational nature of the results, the potential variability in clinical record keeping, and the fact that the data is confined to a single center.
However, they said these results confirm the ongoing unprecedented community transmission of the monkeypox virus among gay, bisexual and other men who have sex with men, which has been observed 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 efforts,” the researchers added.
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