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Monkeypox: Large study highlights new symptoms

According to the largest international monkeypox case series to date, single ulcers, anal lesions, and mouth ulcers are all unique symptoms of the current monkeypox outbreak. The findings underscore the need to expand the case definition of the disease, the researchers said.

“While we expected a variety of skin problems and rashes, we also found that 1 in 10 had pain in the genital area and 15% had anal and/or rectal pain,” the report said. Study lead author John Thornhill, MD, MD, said in a press release. Thornhill is a Consultant Physician in Sexual Health and HIV and a Clinical Senior Lecturer at Barts NHS Health Trust and Queen Mary University of London. “These various presentations highlight that monkeypox infection can be missed or easily confused with common sexually transmitted infections such as syphilis or herpes,” he said.

Since April 2022, There have been more than 15,000 cases of monkeypox infected. The virus has been reported in 66 countries where its existence was previously unknown. The virus, a less severe cousin of smallpox, is endemic in Central and West Africa. In the current outbreak, the vast majority of infections have occurred among men who have sex with men.

In a study published July 21 in The New England Journal of Medicine, researchers reported 528 in 16 countries Clinical details and outcomes of a case of monkeypox infection. All cases were confirmed between April 27 and June 24, 2022. Sexual transmission was suspected in 95% of cases, 98% were identified as gay or bisexual men, and 75% were white. The median age of patients in this case series was 38 years, and 90% of The infection occurred in Europe. 41% of patients were HIV-positive, and 96% of them were receiving antiretroviral therapy. Among patients with HIV-negative or unknown status, 57% reported using PrEP for HIV. About three in 10 (29%) people tested positive for sexually transmitted infections at the same time.

Nearly three-quarters of patients (73%) had anogenital lesions and 41% had mucosal lesions. Fifty-four patients had 1 genital lesion, and 64% had fewer than 10 lesions in total. Fever (62%), swollen lymph nodes (56%), lethargy (41%), and myalgia (31%) were common symptoms preceding the rash. Seventy patients (13%) required hospitalization, the most common being severe anorectal pain and soft tissue superinfection. Only 5% of patients received monkeypox-specific treatments: intravenous or topical cidofovir (2%), tecovir (2%), and vaccinia immunoglobulin (

Jeffrey G. Dr Lausner

This study “importantly reinforces our current understanding that the vast majority of cases are sex-related and occur primarily in males. men who have sex with men,” said Jeffrey Klausner, MD, an infectious disease specialist at the Keck School of Medicine. USC Los Angeles MD in an interview with Medscape Medical News. He was not involved in this study. “Anyone can get monkeypox, but it spreads most efficiently through what we call dense networks — where there is frequent, close personal contact,” he said. “As it happens, gay men and other men who have sex with men have some of these networks.”

The fact that most lesions are present in the genital and anal areas — a unique outbreak — — he noted, suggesting that the infection was spread through close contact. Still, there’s not enough evidence that monkeypox is sexually transmitted. While most semen samples in the study tested positive for monkeypox virus DNA, it was unclear whether enough virus was present to cause transmission, Thornhill said. He noted that more research is needed.

Klausner also stressed the importance of developing new tests and diagnosing monkeypox early to prevent transmission. Laboratory tests for monkeypox require swabs from the lesions, but the study showed that most patients had obvious symptoms before the standard rash or lesions appeared, he said. He noted that reliable tests using saliva or throat swabs could help detect infections more quickly. Patients are considered most contagious when they develop lesions, so diagnosing patients before this stage will allow them to be isolated more quickly, Klausner said.

California-based laboratory company Flow Health announced a saliva-based PCR test for monkeypox on July 9, despite warnings from the U.S. Food and Drug Administration (FDA) that in addition to Test results for sample types other than lesion swabs may be inaccurate. “The FDA is unaware of clinical data supporting the use of other sample types, such as blood or saliva, for monkeypox virus testing,” the agency said in a July 15 statement. False test results. “

Klausner reports no relevant financial relationship.

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