NEW DELHI: People infected with monkeypox during the ongoing global outbreak display symptoms not typically associated with the viral infection, a study published in the British Medical Journal said.
The findings are based on 197 confirmed monkeypox cases at an infectious disease centre in London between May and July 2022, the study said.
Some common symptoms they described include rectal pain and penile swelling (oedema), which differ from those described in previous outbreaks.
The researchers recommend that clinicians consider monkeypox infection in patients with these symptoms.
Those with confirmed monkeypox infection with extensive penile lesions or severe rectal pain "should be considered for ongoing review or inpatient management,” the report added.
All 197 participants in the study were men (average age of 38 years), of whom 196 identified as gay, bisexual, or other men who have sex with men.
All patients presented with lesions on their skin or mucosal membranes, most commonly on the genitals or the perianal area.
Most (86%) of patients reported systemic illness affecting the entire body.
The most common systemic symptoms were fever (62%), swollen lymph nodes (58%), and muscle aches and pain (32%).
In contrast with existing case reports suggesting that systemic symptoms precede skin lesions, 38% of patients developed systemic symptoms after the onset of mucocutaneous lesions, while 14% presented with lesions without systemic features.
Seventy-one patients reported rectal pain, 33 sore throats, and 31 penile oedemata, while 27 had oral lesions, 22 had a solitary lesion, and nine had swollen tonsils.
The researchers said solitary lesions and swollen tonsils were not previously known to be typical of monkeypox infection and could be mistaken for other conditions.
Just over a third (36%) of participants also had HIV infection and 32% of those screened for sexually transmitted diseases had a sexually transmitted infection.
Overall, 20 (10%) participants were admitted to the hospital to manage 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. 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.