New clinical symptoms of monkeypox infection, which will facilitate future diagnosis and help slow the spread of infection, The New England Journal of Medicine (NEJM) reported a case series resulting from an international collaboration of researchers from 16 countries.Currently, the spread of the virus disproportionately affects men of nontraditional orientation: 98% of those infected belong to this group. Although intimacy is the most likely route of transmission in most cases, the researchers emphasize that the virus can be transmitted by any close physical contact through large droplets as well as through clothing and other surfaces.Many of the infected people examined in the study had symptoms that are not recognized in current medical definitions of monkeypox. These symptoms included isolated genital lesions and ulcers in the mouth or anus. The clinical symptoms are similar to those of sexually transmitted infections (STIs) and can easily lead to misdiagnosis. In some people, anal and oral symptoms led to hospitalization for pain and difficulty swallowing. Researchers also found that one in 10 people had only one skin lesion in the genital area, and 15 percent had pain in the anus and/or rectum. These different manifestations underscore that monkeypox infection can be missed or easily confused with common sexually transmitted infections such as syphilis or herpes. Scientists have also found monkeypox virus in a large proportion of semen samples taken from people who have had smallpox. However, this may be coincidental, as it is not known whether it is present at high enough levels to contribute to sexual transmission, the study authors note.
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