CDC: Monkeypox May Present With Genital Sores, No Prior Fever

Clinicians should be highly suspicious for monkeypox infection if a patient has an unusual rash, plus a travel history to a country with confirmed cases, among other factors, the CDC said on Friday.

In a Health Alert Network advisory, the agency provided more detail about the type of lesions characteristic of monkeypox, as well as the risks of close or “intimate” contact with someone with a rash or between men engaging in casual sex, including those who met through a website, an app, a bar, or a party.

Unlike prior cases, this recent outbreak of monkeypox does not always start with flu-like symptoms prior to the onset of rash, the agency noted, but “some recent cases have begun with characteristic, monkeypox-like lesions in the genital and perianal region,” which may lead to the infection being confused with sexually transmitted infections, such as syphilis or herpes.

The CDC said that clusters of monkeypox infection have been reported in countries that don’t normally have these outbreaks, including a cluster of cases among four men who have sex with men (MSM). In addition to the lesions located on the genital or perianal area, some patients may present with proctitis, or an inflammation of the rectum.

“Some evidence suggests that cases among MSM may be epidemiologically linked; the patients in this cluster were identified at sexual health clinics,” the agency wrote in their advisory.

The average incubation period for symptom onset is 5 to 13 days, and a patient is no longer considered contagious when the lesions crust over to scabs, “those crusts have separated,” and fresh skin forms underneath.

Monkeypox is transmitted through contact with bodily fluids and sores, or through large respiratory droplets, which requires “prolonged face-to-face contact,” the agency noted. Transmission has also been reported through fomites and from animals to humans.

There is no specific treatment for monkeypox, the CDC said, though because it is an orthopox virus, smallpox treatment “may prove beneficial.” Those with direct contact with a patient who has monkeypox should be closely monitored, and may receive post-exposure prophylaxis via smallpox vaccine “under an Investigational New Drug Protocol.”

If a clinician treats a patient with a suspected case of monkeypox, they should contact their state or local public health department. The agency also advised contact tracing for individuals who had contact with the symptomatic patient; these individuals should be monitored for 21 days.