Symptoms of monkeypox in UK patients differ from previous outbreaks: study

According to a study published in the journal The Lancet Infectious Diseases on Saturday, the symptoms of monkeypox patients in the UK differ from those seen in previous outbreaks elsewhere in the world.

Patients in this group had a higher prevalence of skin lesions in the genital and anal area and a lower prevalence of fatigue and fever than in cases of previously studied monkeypox outbreaks, according to the study results.

The researchers suggest that, based on these findings, current case definitions for “probable cases” of monkeypox should be revised to help identify cases.

According to the study, the high prevalence of genital skin lesions among patients and the high rate of concurrent sexually transmitted infections mean that sexual health clinics are likely to see further cases of monkeypox in the future.

The researchers call for additional resources to support services in managing this condition.

Nicolo Girometti, from Chelsea & Westminster Hospital NHS Foundation Trust, said that currently the UK and several other countries are seeing a rapid rise in cases of monkeypox among people attending sexual health clinics, with no apparent link to the countries where the disease is endemic.

He said Monkeypox is a new diagnosis in the sexual health setting and that our study, the first to publish cases of this outbreak in the UK, will support case finding and future clinical care.

Researchers collected data from monkeypox patients on their travel history, sexual history and clinical symptoms at four sexual health centers in London, UK. Confirmed cases were defined as individuals with laboratory-confirmed infection using an RT-PCR test.

Those diagnosed with monkeypox were informed of the isolation measures and regularly assessed afterwards via telephone wellness checks.

The 54 patients observed in this study represent 60% of the cases reported in the UK during the 12-day study period in May this year.

All but two of the patients in the cohort were unaware of having been in contact with a known case and none reported having traveled to sub-Saharan Africa, but many had recently visited other European countries.

All patients identified as men who have sex with men and the median age was 41 years.

Up to 90% of patients who answered questions about sexual activity reported having had at least one new sexual partner in the three weeks preceding symptoms, and almost all reported using condoms irregularly during of this same period.

The researchers observed that more than half of the patients had had more than five sexual partners in the 12 weeks prior to their diagnosis of monkeypox and that they were all symptomatic and had skin lesions; 94% of patients had at least one skin lesion on the genital or perianal skin.

Most of the patients had mild illness and recovered while self-isolating, but five people required hospitalization due to pain or infection of the skin lesions. All improved and were discharged with a median of seven days in hospital.

Ruth Byrne, from Chelsea & Westminster Hospital NHS Foundation Trust, said the commonly seen symptom of skin lesions in the anal and penile areas, and the fact that a quarter of patients tested positive for gonorrhea or chlamydia at the same time that monkeypox infection, suggests that transmission of monkeypox virus in this cohort occurs from close skin to skin, for example in the context of sexual activity.

18% of the patients in the group reported no early symptoms before the appearance of the skin lesions.

A lower proportion of patients in the group reported feeling weak and tired or having a fever than in studies of cases from previous outbreaks.

The researchers also observed significant differences in the clinical characteristics of this cohort compared to previous cases reported in previous outbreaks in other countries.

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