As cases of monkeypox continue to rise globally and domestically, health officials are warning the public to look out for symptoms of rash, fever, malaise, swollen glands and/or fever.
However many may be inadvertently ignoring lesions on their skin thinking they don’t look like published cases of monkeypox.
In fact, early monkeypox lesions may appear to look like simple bumps or pimples.
They can also look like ulcerations with scabs.
The UK Health Security agency along with CDC have published the following pictures to help those with a new onset rash determine if they need to seek testing for monkeypox.
Of course any question about one’s rash, symptoms or exposure should prompt immediate medical evaluation.
Some monkeypox lesions can cause necrosis (cell death) in immunocompromised individuals.
Dailymail reports this man who also had HIV, began to lose parts of his nose to monkeypox.
CDC Breaks Down Who Got Monkeypox And How
The CDC published their Morbidity and Mortality Weekly Report (MMWR) describing the cases reported during the time period of May 17–July 22, 2022.
Although US case counts during that time were 2,891, data came from case report forms which totaled, 1,195 (41%) cases.
On the whole, 99% of these cases occurred in men, 95% reported male-to-male sexual or close intimate contact during the three weeks leading up to symptoms.
Among the 88% of cases with available data:
- 41% were among non-Hispanic White (White) persons
- 28% among Hispanic or Latino (Hispanic) persons
- 26% among non-Hispanic Black or African American (Black) persons.
Not all patients had the textbook described symptoms of fever, malaise, swollen lymph glands and rash.
Forty-two percent of persons with monkeypox with available data did not report the typical prodrome as their first symptom, and 46% reported one or more genital lesions during their illness.
The CDC states 41% had HIV infection at the time of their monkeypox illness.
Of the 241 cases (20%) reported as being travel-associated or locally acquired, 178 (74%) were classified as locally acquired thus 26% travel-associated.
In terms of sexual activity of patients, the CDC reports:
Among 291 men who reported information about their male sexual partners during the 3 weeks preceding symptom onset, 80 (27%) reported one partner, 113 (40%) reported two to four partners, 42 (14%) reported five to nine partners, and 56 (19%) reported 10 or more partners. Among 86 men with information reported, 33 (38%) reported group sex, defined as sex with more than two persons, at a festival, group sex event, or sex party.
In terms of symptoms reported:
- rash (100%)
- fever (63%)
- chills (59%)
- lymphadenopathy (59%)
- purulent or bloody stools (21%)
- rectal pain (22%)
- rectal bleeding (10%)
In terms of first symptoms noticed, 58% reported at least one prodromal symptom (such as fever, chills) but 42% of patients began their illness with a rash.
In terms of distribution, rash was reported on the following body parts:
- genitals (46%)
- arms (40%)
- face (38%)
- legs (37%)
In terms of widespread rash or localized, among 718 people:
- 238 (33%) reported rash in one region
- 126 (18%) in two regions
- 98 (14%) in three regions
- 256 (36%) in four or more regions
These numbers differ from previous outbreaks where the monkeypox rash would start on the face and move downward to affect the trunk and extremities.
What is Monkeypox?
Discovered in 1958 in monkeys but first seen in humans by the 1970s, monkeypox is an illness caused by a virus classified under the Orthopoxvirus genus in the family Poxviridae.
It is a zoonotic illness originating from animals, such as rodents, rabbits, squirrels, prairie dogs, rats, and monkeys, and can affect humans if the former bites, scratches, or has close contact with the latter.
The WHO is currently working to change the name from “monkeypox” to a more generic term.
The illness is more common in Central and West Africa but once a human contracts the illness, they can spread it to other humans by close contact and “large respiratory droplets“, including during sex. It is unclear if fluids exchanged during sex is a source of infection.
The incubation period can last anywhere between 6-21 days (length of time from exposure/infection to onset of symptoms).
It is very rare, and the last previous monkeypox outbreak in the US occurred in 2003.
That year 72 total cases were confirmed and suspected linked to prairie dogs purchased at pet stores by a similar distributor.
Symptoms of monkeypox include:
- fever
- chills
- sore or dry throat
- fatigue
- muscle aches
- backache
- headache
- swollen lymph glands (lymphadenopathy)
- rash (that can begin flat then form pustules and vesicles and then scab and fall off). The rash can begin on the genitals or on the face and then moves to the rest of the body.
to name a few.
Most cases resolve in 2-4 weeks but some cases can cause blindness if the lesions affect the eye and secondary infections, including pneumonia and sepsis.
Although there is no specific monkeypox antiviral the CDC discusses antivirals designed to fight smallpox and their potential use to fight severe monkeypox cases.
These include Tecovirimat, Cidofovir, Brincidofovir as well as Vaccinia Immune Globulin Intravenous (VIGIV).
Sources vary on mortality rate as it ranges from 1-15%, especially if victims are not vaccinated.
According to the CDC there is a vaccine that has 85% efficacy in preventing severe monkeypox.
JYNNEOSTM (also known as Imvamune or Imvanex), has been licensed in the United States to prevent monkeypox and smallpox. Because monkeypox virus is closely related to the virus that causes smallpox, smallpox vaccine can also protect people from getting monkeypox.
Theories surrounding why Monkeypox is spreading beyond Africa include a lack of immunity in the younger population to smallpox, being smallpox vaccination ended in the 70’s, a rapidly mutating strain of monkeypox, and altered immunity from the COVID virus.
Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is a Board Certified Family Physician
@DrDaliah
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