The symptoms of monkeypox patients in Britain differ from those seen in previous outbreaks elsewhere in the world, according to a study published in The Lancet Infectious Disease journal on Saturday.
Researchers looked at 54 patients attending sexual health clinics in London, UK, and were diagnosed with monkeypox over a 12-day period in May this year.
The finding suggests that patients in this group had a higher prevalence of skin lesions in the genital and anal region and a lower prevalence of fatigue and fever than the previously studied monkeypox cases.
Based on these findings, the researchers suggest that current case definitions for ‘probable cases’ of monkeypox should be reviewed to help identify cases.
They also speculate that the high prevalence of genital skin lesions in patients and the high rate of co-occurring sexually transmitted infections mean that sexual health clinics are likely to see additional monkeypox cases in the future.
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Researchers call for additional resources to support services in managing this condition.
Niccol Girometti, of the Chelsea and Westminster Hospital NHS Foundation Trust, said: “Currently, the UK and many other countries are seeing a rapid increase in cases of monkeypox among individuals attending sexual health clinics, with no apparent evidence from those countries. The relationship is not where the disease is endemic.” ,
“Monkeypox is a novel diagnosis within the sexual health setting and our study, the first to be published on cases in this UK outbreak, will support future case discovery and clinical care,” Girometti said.
Researchers collected data from patients with monkeypox at four sexual health centers in London, UK.
Confirmed cases were defined as individuals with laboratory-confirmed infection using RT–PCR testing.
They recorded data about the patient’s travel history, sexual history and clinical symptoms.
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Individuals suffering from monkeypox were advised of isolation measures and subsequently regularly assessed through telephone welfare checks.
The 54 patients seen in this study represent 60 per cent of the cases reported in the UK during the 12-day study period during May this year.
All except two patients in the cohort were not known to have been in contact with a known case and none reported travel to sub-Saharan Africa, although many had recently visited other European countries.
The researchers said that all the patients, identified as men who had sex with men, had an average age of 41 years.
90 percent of patients who answered questions on sexual activity reported at least one new sexual partner during the three weeks prior to symptoms, and nearly all reported inconsistent condom use during the same period.
More than half of the patients had more than five sexual partners in the 12 weeks before their diagnosis of monkeypox, the researchers said.
The patients were all symptomatic and presented with skin lesions; 94 percent of patients had at least one skin lesion on the genital or perianal skin.
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Most patients had mild illness and recovered during home isolation, but five individuals required hospitalization due to pain or infection with skin lesions.
All improved and were discharged in the middle of seven days of hospitalization.
“The commonly observed symptomatology of skin lesions in the anus and penile areas, and the fact that a quarter of patients tested positive for monkeypox infection at the same time for gonorrhea or chlamydia, suggests that in this cohort Monkeypox virus is transmitted by close skin-to-skin, for example in the context of sexual activity,” said Ruth Byrne from the Chelsea & Westminster Hospital NHS Foundation Trust.
The researchers observed significant differences in the clinical characteristics of this group compared to previous cases reported from earlier outbreaks in other countries.
A lower proportion of patients in the group reported feeling weak and tired or feverish compared to studies on cases from previous outbreaks, the researchers said.
In addition, 18 percent of the patients in the group did not report any early symptoms prior to the onset of skin lesions, he said.