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Explained: The new Monkeypox symptoms found in UK patients

A recent study found new symptoms of Monkeypox like more skin lesions in genital and anal areas and fewer cases of tiredness and fever

New symptoms of monkeypox in UK patientsMonkeypox occurred in countries of Central and West Africa but has been detected in more than 20 countries this this year so far. (Representative) (Source: Wikimedia Commons)

Monkeypox patients from the UK exhibited different symptoms from those observed in previous outbreaks, according to a study published in The Lancet Infectious Diseases Journal on July 1 (Friday). The researchers also recommended that the UK Health Security Agency should review its current case definitions of monkeypox to better help identify cases.

The study looked at 54 patients who attended sexual health clinics in London, the UK and were diagnosed with monkeypox during a 12-day period in May 2022. Researchers observed differences in the symptoms of these cases, as compared to previous monkeypox outbreaks, including the location of skin lesions and a lower prevalence of tiredness and fever.

This study was conducted by researchers from Chelsea & Westminster Hospital NHS Foundation Trust, Imperial College Healthcare NHS Trust, Central London Community Healthcare NHS Trust and Imperial College London.

Monkeypox and its spread

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Monkeypox is a zoonotic disease caused by a virus belonging to the Orthopoxvirus genus, with endemic circulation reported in African regions, predominantly west and central Africa. Few imported cases of monkeypox virus were reported in recent years outside Africa including the UK, where three of seven cases (2018–21) were related to onward transmission, including the first reported household cluster outside Africa and one nosocomial transmission (infections that develop as a result of staying in hospitals).

The disease was largely restricted to west and central Africa until a few months ago. After the recognition of an initial monkeypox virus case in an individual who travelled to the UK from Nigeria on May 7, 2022, a cumulative total of 1285 laboratory-confirmed monkeypox virus cases had been reported by 23 countries as of June 8, 2022. The size and spread of outbreak clusters across Europe are growing, and outbreak clusters have also been identified in the Americas and the Eastern Mediterranean and Western Pacific regions, mainly in men attending sexual health centres.

“Currently, the UK and several other countries are seeing a rapid increase in monkeypox cases among individuals attending sexual health clinics, with no apparent links to countries where the disease is endemic. Monkeypox is a novel diagnosis within the sexual health setting and our study, the first to publish on cases from this UK outbreak, will support future case finding and clinical care,” said one of the study’s authors, Dr Nicolo Girometti, of the Chelsea & Westminster Hospital NHS Foundation Trust.

What did the study find?


The analysis finds that in all 54 cases of monkeypox, the patients were identified as men who have sex with men. A high proportion of cases had skin lesions in their anus or genital regions, suggesting transmission during close skin-to-skin contact, such as sexual activity. The authors of the report have also called for additional resources to support sexual health and other specialist services in managing the current monkeypox outbreak.

The 54 patients observed in this study represent 60 per cent of the cases reported in the UK during the 12-day study period in May 2022. All except two of the patients in the cohort were not aware of having been in contact with a known case and none reported travel to sub-Saharan Africa, however many had recently visited other European countries. All patients identified as men who have sex with men and the median age was 41 years.

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90 per cent of the patients who responded to the questions on sexual activity (47 of 52) reported at least one new sexual partner during the three weeks prior to symptoms, and almost all (49 of 52) reported inconsistent condom use at this same time period. Over half of the patients (29 of 52) had more than five sexual partners in the 12 weeks prior to their monkeypox diagnosis.

The patients were all symptomatic and presented with skin lesions and 94 per cent (49 of 52) of patients had at least one skin lesion on the genital or perianal skin. Mostly, the patients had a mild illness and recovered whilst isolating at home, but five individuals required hospital admission due to pain or infection of the skin lesions. All improved and were discharged with a median of seven days of hospital admission.

Resembles sexually transmitted diseases

“The commonly observed symptom of skin lesions in the anal and penile areas, and the fact that a quarter of the patients tested positive for gonorrhoea or chlamydia at the same time as the monkeypox infection, suggests that transmission of the monkeypox virus in this cohort is occurring from close skin-to-skin, for example in the context of sexual activity,” said Dr Ruth Byrne, from the Chelsea & Westminster Hospital NHS Foundation Trust in the report. “However, this finding may be biased by the fact that we are sexual health providers and hence may not reflect transmission in the wider population,” Dr Byrne said.

Dr Byrne also noted that it was possible that at various stages of the infection monkeypox may mimic common STIs, such as herpes and syphilis, in its presentation. “It’s important that sexual health clinicians and patients are aware of the symptoms of monkeypox as misdiagnosis of the infection may prevent the opportunity for appropriate intervention and prevention of onward transmission,” she added.

Dr Girometti also said in the report, “Given the suggested route of infection via contact during sexual activity and the number of clinical findings differing from previous descriptions, we suggest that case definitions currently detailing symptoms such as acute illness with fever should be reviewed to best adapt to the current findings, as at least one in six of this cohort would have not met the current ‘probable case’ definition.”


The authors predict that the high prevalence of genital skin lesions in patients and the high rate of co-occurring sexually transmitted infections means that sexual health clinics are likely to see additional monkeypox cases in the future. They call for additional resources to support services in managing this condition.

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First published on: 02-07-2022 at 08:01:25 pm
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