Table 3.
Clinical presentation, physical examination, and clinical course among confirmed monkeypox cases reported to GeoSentinel (May 1–July 1, 2022)
| Patients (n=226) | First symptom (n=187)* | ||
|---|---|---|---|
| Signs and symptoms (patient-reported) | |||
| Rash or skin lesions anywhere on the body | 137 (61%) | 28 (15%) | |
| Fever (subjective or measured) | 131 (58%) | 44 (24%) | |
| Genital or perianal lesions | 124 (55%) | 56 (30%) | |
| Fatigue or malaise | 93 (41%) | 18 (10%) | |
| Enlarged lymph nodes | 82 (36%) | 8 (4%) | |
| Sore throat (pharyngitis) | 54 (24%) | 10 (5%) | |
| Chills | 50 (22%) | 1 (1%) | |
| Headache | 35 (16%) | 2 (1%) | |
| Rectal pain | 33 (15%) | 4 (2%) | |
| Muscle aches (myalgia) | 32 (14%) | 6 (3%) | |
| Sweats | 20 (9%) | 0 | |
| Itching (pruritis) | 18 (8%) | 4 (2%) | |
| Cough | 16 (7%) | 1 (1%) | |
| Diarrhoea | 13 (6%) | 1 (1%) | |
| Back pain | 10 (4%) | 1 (1%) | |
| Urgency to defecate (tenesmus) | 10 (4%) | 1 (1%) | |
| Rectal bleeding | 8 (4%) | 0 | |
| Pus or blood in stool | 6 (3%) | 0 | |
| Runny nose (rhinitis) | 5 (2%) | 0 | |
| Pain with urination (dysuria) | 4 (2%) | 1 (1%) | |
| Nausea | 3 (1%) | 0 | |
| Oedema | 2 (1%) | 0 | |
| Red eyes (conjunctivitis or keratitis) | 2 (1%) | 1 (1%) | |
| Abdominal pain | 1 (1%) | 0 | |
| None | 1 (1%) | 0 | |
| Other† | 11 (5%) | 5 (3%) | |
| Physical examination | |||
| Documented fever | |||
| Yes | 31/170 (18%) | .. | |
| No | 139/170 (82%) | .. | |
| Rash or skin lesions | |||
| Yes | 221/223 (99%) | .. | |
| No | 2/223 (1%)‡ | .. | |
| Composite rash score | |||
| Data available, n | 207 | .. | |
| Median (range; IQR) | 6 (1–165; 6–18) | .. | |
| Anatomical location§ | |||
| Genitals | 101/221 (46%) | .. | |
| Perianal | 60/218 (28%) | .. | |
| Trunk | 57/215 (27%) | .. | |
| Arms | 56/213 (26%) | .. | |
| Face | 51/222 (23%) | .. | |
| Mouth, lips, or oral mucosa | 43/221 (20%) | .. | |
| Palms of hands | 25/224 (11%) | .. | |
| Head | 20/224 (9%) | .. | |
| Soles of feet | 9/225 (4%) | .. | |
| Neck | 7/224 (3%) | .. | |
| Other¶ | 14/222 (6%) | .. | |
| Lesions at same stage of development | |||
| Yes | 103/178 (58%) | .. | |
| No | 75/178 (42%) | .. | |
| Lesions of same size | |||
| Yes | 80/172 (47%) | .. | |
| No | 92/172 (54%) | .. | |
| Appearance of lesions | |||
| Well-circumscribed | 124/197 (63%) | .. | |
| Umbilicated | 112/197 (57%) | .. | |
| Deep-seated and profound in the skin | 68/197 (35%) | .. | |
| Other‖ | 76/197 (39%) | .. | |
| Lymphadenopathy | |||
| Yes | 134/219 (61%) | .. | |
| No | 85/219 (39%) | .. | |
| Anatomic location of lesions | |||
| Inguinal | 92/131 (70%) | .. | |
| Cervical | 45/131 (34%) | .. | |
| Submandibular | 13/131 (10%) | .. | |
| Axillary | 5/131 (4%) | .. | |
| Other** | 4/131 (3%) | .. | |
| STI testing†† | |||
| Any STI | 29/193 (15%) | .. | |
| Gonorrhoea | 9/193 (5%) | .. | |
| Primary or secondary syphilis | 5/193 (3%) | .. | |
| Chlamydia | 4/193 (2%) | .. | |
| Herpes simplex virus infection | 4/193 (2%) | .. | |
| Latent syphilis (early, late, or unknown) | 3/193 (2%) | .. | |
| Lymphogranuloma venereum | 1/193 (1%) | .. | |
| Molluscum contagiosum | 1/193 (1%) | .. | |
| Mycoplasma genitalium | 1/193 (1%) | .. | |
| Other syphilis (neurosyphilis, ocular syphilis, or otosyphilis) | 1/193 (1%) | .. | |
| Streptococcal urethritis | 1/193 (1%) | .. | |
| Chancroid | 0 | .. | |
| HIV (new diagnosis) | 0 | .. | |
| Human papilloma virus infection | 0 | .. | |
| Trichomoniasis | 0 | .. | |
| Treatment | |||
| No known monkeypox treatment | 200 (89%) | .. | |
| Cidofovir | 14 (6%)‡‡ | .. | |
| Tecovirimat | 10 (4%)‡‡ | .. | |
| Vaccinia immune globulin | 1 (1%) | .. | |
| Brincidofovir | 0 | .. | |
| Outcomes | |||
| Admitted to hospital at last contact | |||
| Yes | 30 (13%) | .. | |
| No | 196 (87%) | .. | |
| Admission to intensive care unit | |||
| Yes | 0 | .. | |
| No | 30 (100%) | .. | |
| Reason for hospital admission | |||
| Severe illness§§ | 16 (53%) | .. | |
| Need for isolation | 10 (33%) | .. | |
| Other¶¶ | 4 (13%) | .. | |
| Deaths | 0 | .. | |
Data are n (%) or n/N (%), unless otherwise specified. STI=sexually transmitted infection.
More than one first symptom could be listed if they occurred simultaneously.
Included anal discharge (n=2), anal pain (n=2), arthralgia (n=2), dysphagia (n=2), groin pain (n=2), constipation (n=1), decreased urine output (n=1), foot dysesthesia (n=1), nasal congestion (n=1), and weight loss (n=1).
Of the two patients without rash or lesions on physical exam, one had a previous rash (resolved), and one was asymptomatic but had contact with a known case.
Most common range of lesions was 2–10 at all anatomical sites.
Included pubis (n=3), inguinal (n=3), lower extremities (n=2), hands (n=1), back (n=1), buttocks (n=1), fingers (n=1), forearms (n=1), and unspecified (n=1).
Included descriptions such as papules, vesicles, ulcers, and necrosis.
Included generalised (n=2), preauricular (n=1), and root of penis (n=1).
One patient had two STIs (Chlamydia and herpes simplex virus infection).
One patient received both cidofovir and tecovirimat.
Documentation for severe illness included severe pain (n=4), dysphagia (with or without airway compromise; n=3), need for surgical drainage of perianal abscess (n=1), and Escherichia coli sepsis with high fever with loss of consciousness (n=1).
Included supportive care (n=3) and medical curiosity (n=1).