Penile swelling and rectal pain are recognized as symptoms of monkeypox

New symptoms reported in monkeypox patients

The study conducted by researchers at the Guys and St Thomas’ NHS Foundation Trust included 197 patients who were confirmed to be infected with MPV in the months between May and July 2022.

All patients included in the study were male, of which 196 identified as being gay, bisexual, or men who have sex with men (MSM). 71 patients reported experiencing rectal pain, while 31 reported penile swelling during their infection. In about a fifth of these cases, the symptoms were bad enough for patients to seek hospital admission for their management.

All participants of the study reported some lesion either on their skin or on the mucous membranes, such as those lining the mouth or genitals. Although monkeypox is described as a condition with a widespread rash and numerous fluid-filled lesions, 22 patients showed only one lesion, the study found.

Nine patients also reported swollen tonsils, a symptom that is not usually associated with monkeypox.

Symptoms not listed in health agency guidelines

According to the New Scientist report, penile swelling, rectal pain, swollen tonsils as well as a single lesion do not feature in the list of symptoms that the U.S. CDC or WHO use to define monkeypox infection.

On July 25th, the U.K. Health Security Agency included a single lesion in its symptoms list along with proctitis - pain in the anus or rectum or bleeding. While this can help patients report their symptoms and test themselves, it does not require an overhaul of the disease symptoms. As many as 86 percent of the patients in the study continued to report symptoms such as fever, swollen lymph nodes, muscle ache, and pain during the course of their infection.

70 of the 197 participants in the study were also HIV positive, while 56 had a sexually transmitted infection. Researcher Julia Bilinska, who was involved in the study, told New Scientist that co-infection could be a reason why these individuals showed different symptoms.

The study also found that only 26.5 percent of patients reported that they had come in contact with someone who was confirmed to have monkeypox or its typical symptoms. So, it is likely that the disease could be spreading without showcasing any symptoms at all. This could change also help health agencies determine how they approach disease transmission.

The research findings were published in BMJ.

Abstract:

Objective: To characterize the clinical features of monkeypox infection in humans.

Results: The median age of participants was 38 years. All 197 participants were men, and 196 identified as gay, bisexual, or other men who have sex with men. All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%). 170 (86.3%) participants reported systemic illness. The most common systemic symptoms were fever (n=122, 61.9%), lymphadenopathy (114, 57.9%), and myalgia (n=62, 31.5%). 102/166 (61.5%) developed systemic features before the onset of mucocutaneous manifestations and 64 (38.5%) after (n=4 unknown). 27 (13.7%) presented exclusively with mucocutaneous manifestations without systemic features. 71 (36.0%) reported rectal pain, 33 (16.8%) sore throat, and 31 (15.7%) penile oedema. 27 (13.7%) had oral lesions and 9 (4.6%) had tonsillar signs. 70/195 (35.9%) participants had concomitant HIV infection. 56 (31.5%) of those screened for sexually transmitted infections had a concomitant sexually transmitted infection. Overall, 20 (10.2%) participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling.

Conclusions These findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the U.K. and many other non-endemic countries. A variable temporal association was observed between mucocutaneous and systemic features, suggesting a new clinical course to the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile oedema. These presentations should be included in public health messaging to aid early diagnosis and reduce onward transmission.