Monkeypox symptoms are different from previous outbreaks, doctors warn

top line

People infected with monkeypox during the ongoing global outbreak are showing symptoms not normally associated with the viral infection, according to research published in the journal. british medical journal on Thursday, meaning the cases could be ignored by doctors as authorities scramble to contain the growing outbreak.

Main facts

Rectal pain and penile swelling, symptoms not usually associated with smallpox infection, are commonly reported among people infected with smallpox during the current outbreak, researchers at the NHS Foundation Trust of Guy and St Thomas in London have found.

Of the 197 participants with confirmed smallpox infections between May and July — all were men and all but one identified as gay, bisexual or other men who have sex with men — 71 reported rectal pain and 31 reported penile swelling.

Twenty of those men were hospitalized for treatment of symptoms, the researchers said, most often for rectal pain or penile swelling.

Swollen tonsils and solitary lesions, also non-typical symptoms of monkeypox, were reported in nine and 22 participants, respectively.

The researchers cautioned that these symptoms could be confused with other conditions such as syphilis, ingrown hairs and tonsillitis and could help explain how the smallpox outbreak became so widespread when it was first detected.

big number

14%. That’s the proportion of case studies that don’t meet the UK Health Safety Agency’s (UKHSA) current definition of a likely case of smallpox, the researchers said. Almost half (47%) had symptoms and disease progression that “contradict” the UKHSA definition of probable cases, mainly because they had systemic symptoms such as fever, swollen lymph nodes, and muscle pain after, rather than before, the onset of lesions.

what we don’t know

Experts aren’t sure why monkeypox is causing new symptoms in some people. It is possible that the disease itself has changed and other infections among the patients – 32% selected in the study also had a sexually transmitted infection – means that the way it is transmitted may be playing a role. While smallpox can be transmitted to anyone and is spread primarily through close physical contact, data suggest that the current global outbreak is almost entirely fueled by transmission between gay, bisexual and other men who have sex with men. While the disease is not known to be sexually transmitted, the outbreak is being driven by sexual contact and the WHO has recently changed its stance and advised members of this group to consider reducing the number of sexual partners to contain the disease. Reports from the current outbreak point to much higher rates of skin lesions in the genital and anal areas than expected in previous outbreaks, possibly as a result of where the virus was transmitted.

key background

Monkeypox has been known for decades but has been ignored by most of the world as its spread was largely limited to some areas of Central and West Africa. The virus is believed to be hosted in an unknown species of rodent. It can spread to and between humans by close contact and does not spread easily. Vaccines and treatments, particularly for a related virus, smallpox, are available for smallpox but are in critical shortage. The World Health Organization has designated the outbreak a global public health emergency, its highest alert level due to the rapid worldwide spread. More than 21,000 confirmed cases of monkeypox have been reported worldwide this year, according to the Centers for Disease Control and Prevention, almost all in countries that have historically not reported monkeypox. Nearly 5,000 of them are in the United States. Tests are generally bad and these numbers are likely to be much higher.

additional reading

Smallpox symptoms look different in recent cases than in previous outbreaks, doctors warn (Forbes)

WHO calls Monkeypox a global health emergency (Forbes)

Injuries, Headaches, Debilitating Pain: Gays With Monkeypox Share Their Stories (NBC News)

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