Background
Cases of human monkeypox virus in the UK have historically been limited to infections imported from West Africa. Currently, the UK and several other countries are reporting a rapid increase in monkeypox cases among people attending sexual health clinics, with no apparent epidemiological links to endemic areas. We describe the demographic and clinical characteristics of patients diagnosed with human monkeypox who attend a sexual health center.
Methods
In this observational analysis, we considered patients with confirmed monkeypox virus infection via PCR screening who attended open-access sexual health clinics in London, UK, between 14 and 25 March. May 2022. We report hospitalizations and proportions of concurrent sexually transmitted infections (STIs). and describe our local response within the first 2 weeks of the outbreak.
recommendations
Monkeypox virus infection was confirmed in 54 people, all identified as men who have sex with men (MSM), with a median age of 41 years (IQR 34–45). 38 (70%) of 54 people were white, 26 (48%) were born in the UK, and 13 (24%) were living with HIV. 36 (67%) of 54 individuals reported fatigue or lethargy, 31 (57%) reported fever, and 10 (18%) had no prodromal symptoms. All patients presented skin lesions, of which 51 (94%) were anogenital. Thirty-seven (89%) of 54 individuals had skin lesions involving more than one anatomic site, and four (7%) had oropharyngeal lesions. 30 (55%) of 54 individuals had lymphadenopathy. One in four patients had a concurrent STI. Five (9%) of 54 individuals required hospital admission, mainly for pain or localized bacterial cellulitis that required antibiotic intervention or analgesia. We do not record fatal outcomes.
Interpretation
Transmission of monkeypox virus in the indigenous community is currently observed among MSM in the UK. We found a high proportion of concomitant STIs and frequent anogenital symptoms, suggesting transmissibility through local inoculation during close skin-to-skin or mucosal contact during sexual activity. Additional resources are required to support sexual health and other specialized services in the management of this condition. A revision of the case definition and a better understanding of viral transmission routes are needed to shape infection control policies, education and prevention strategies, and contact tracing.
Money
None.
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