Solitary lesions and swollen tonsils were not known to be typical features of monkeypox infection – meaning healthcare professionals could mistake them for something else
Monkeypox patients who present to doctors are describing symptoms not previously associated with the illness, according to a new study published by the BMJ last week.
Many patients are now reporting rectal pain and penile swelling (oedema), differ from those described in previous outbreaks. Researchers looked at 197 confirmed monkeypox cases at an infectious disease centre in London between May and July 2022.
Ireland has so far had 85 confirmed cases of monkeypox, according to the Health Protection Surveillance Centre (HPSC). Earlier this month, the WHO officially declared monkeypox a global health emergency.
The Department of Health has announced that a smallpox vaccine will be provided to people at high-risk of contracting the illness – including gay and bisexual men, and other vulnerable groups.
“Monkeypox is usually a self-limiting illness, and most people recover within a few weeks, however the rapid spread of infection necessitates further measures beyond those currently in place,” said Minister for Health Stephen Donnelly, upon announcing that the vaccine is to be extended.
“The evidence suggests this approach to targeted pre-exposure prophylaxis may be highly efficient in controlling further spread of the disease.”
All 197 participants in the study published in the BMJ were men (average age 38 years), of whom 196 identified as gay, bisexual, or other men who have sex with men. Every patient presented with lesions on their skin or mucosal membranes, most commonly on the genitals or in the perianal area.
Most (86 per cent) of patients reported systemic illness (affecting the entire body). The most common systemic symptoms were fever (62 per cent), swollen lymph nodes (58 per cent), and muscle aches and pain (32 per cent).
And in contrast with existing case reports suggesting that systemic symptoms precede skin lesions, 38 per cent of patients developed systemic symptoms after the onset of mucocutaneous lesions, while 14 per cent presented with lesions without systemic features.
A total of 71 patients reported rectal pain, 33 sore throat, and 31 penile oedema, while 27 had oral lesions, 22 had a solitary lesion, and nine had swollen tonsils.
Solitary lesions and swollen tonsils were not previously known to be typical features of monkeypox infection and could be mistaken for other conditions. Just over a third (36 per cent) of participants also had HIV infection and 32 per cent of those screened for sexually transmitted infections had a sexually transmitted infection.
Overall, 20 (10 per cent) of participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling. However, no deaths were reported and no patients required intensive hospital care.
Only one participant had recently travelled to an endemic region, confirming ongoing transmission within the UK, and only a quarter of patients had known contact with someone with confirmed monkeypox infection, raising the possibility of transmission by people with no or very few symptoms.