Buttock pain, fevers, lethargy, lesions

  • A groundbreaking study of monkeypox patients around the world reveals some of the most common symptoms.
  • Some patients have only one lesion, making it difficult to diagnose the virus.
  • Transmission through sexual contact was “suspected” in 95% of cases.

A groundbreaking new study of more than 500 diagnosed cases of monkeypox worldwide suggests the disease is frequently missed and misdiagnosed because testing and vaccinations are late. The report’s case studies, which come from around 100 different clinicians working around the world, reveal that some of the most common symptoms of monkeypox in the current epidemic are not always what people think. wait to see.

“Most people have never had training about monkeypox,” lead study author Chloe Orkin, a professor of HIV medicine at Queen Mary University of London, told Insider. “The important thing is to help doctors recognize it, so they don’t confuse it with a sexually transmitted infection.”

Orkin’s study, published Thursday in the New England Journal of Medicine, found that among 528 monkeypox patients identified in 16 countries between April and June, rashes were common (occurring 95% of the time). About 73% of patients had anogenital lesions, while about 10% of patients had only one visible monkeypox lesion on them. 98% of the patients, all of whom agreed to participate in the study, were gay or bisexual men, reflecting the fact that much of monkeypox transmission in this outbreak occurred through sexual contact.

Some patients had difficulty swallowing or going to the toilet

a man receiving the monkeypox vaccine

Cory Hawkins, 35, receives a dose of monkeypox vaccine at the Silver Room Block Party near Burnham Park on July 17, 2022 in Chicago.

Armando Sanchez/Chicago Tribune/Tribune News Service via Getty Images

Cases ranged from very mild to so painfully debilitating that patients became unable to use the toilet or swallow, Orkin said.

“People weren’t just showing skin issues,” she added, which is different from how the virus has been characterized in past outbreaks. “They also had problems inside the anus and inside the mouth. And sometimes those problems were so bad that people had to be hospitalized for pain.”

Symptoms of monkeypox infection that occurred before people developed a rash included fevers (in 62% of patients), lethargy (41% of the time), muscle aches (31%) and headaches (27%). Among the 70 patients hospitalized as a result of the study, the most common problems were severe anorectal pain (21 patients), skin infections (18 patients) and difficulty swallowing (five patients).

Early treatment is essential, not only to help contain the virus, but also because available antiviral treatments work best when given early in an infection.

“It can easily be missed,” Orkin said. “And it looks like he was missed.”

Dr. Lilian Abbo, of the University of Miami, expressed frustration in a phone call from the Infectious Diseases Society of America last week that some patients in South Florida had to schedule multiple visits with different providers before eventually receiving a positive diagnosis of monkeypox.

At least 2,323 cases of monkeypox have been diagnosed so far in the United States, according to the Centers for Disease Control and Prevention, and the World Health Organization estimates that monkeypox is present in at least 50 countries across the world.

monkeypox lesions of different types

United Kingdom HSA

Clinicians don’t know if the monkeypox currently circulating is really a different type of virus than they’ve seen in the past, or if the different virus presentations currently seen are more reflective of how monkeypox is transmitted from person to person. to the person (through skin-to-skin contact during sexual contact.)

Although monkeypox DNA was detected in the semen of some of the patients tested in this study, it is still unclear what this finding might mean for the potential sexual transmission of this virus.

“You can find a virus in semen, but that doesn’t necessarily mean it’s a public health concern,” said Dr. Lawrence Purpura, an infectious disease expert at Columbia University Irving Medical Center.

Purpura, who was not involved in this research and has studied viruses in semen including Ebola and COVID, said “just detecting a virus doesn’t immediately raise red flags that we should be worried about. sexual transmission at this point, but it is. I think there needs to be enough momentum to really study it – and study it quickly, to determine if it’s a potential risk.”

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