Atypical Presentation of Monkeypox Creates Confusion

In a press briefing on July 13, the Pan American Health Organization announced that there had been a surge in monkeypox cases and that specialists are predicting an even greater increase. On Saturday, July 23, the World Health Organization declared the disease a Public Health Emergency of International Concern.

"The focus of our organization is to alert and ensure prevention aimed primarily at more vulnerable populations, in particular, men who have sex with men ," PAHO officials stated. Current clinical pictures are presenting with anal pain and rectal bleeding. And contrary to what one would expect, the genital or perineal/perianal lesions are not spreading further but are appearing at different stages of development, even without the occurrence of fever, malaise, or other symptoms .

This was the first of many atypical cases that Santini has treated. The classic differential diagnosis, which she expected to bewith only a few lesions, became herpes, molluscum, granuloma venereum, and other infections that present with gingival lesions."Ocular lesions have now been described. We haven't seen any of these [yet], but ophthalmologists also need to be on the alert," Santini added.

Other requirements, such as a history of travel or an epidemiologic link to individuals with a history of travel to countries with confirmed cases, are no longer as relevant. As of July 9, of the 218 confirmed cases in Brazil, only 36 reported having traveled outside of Brazil. Retrospective testing of anorectal and oropharyngeal swabs collected to screen for gonorrhea and chlamydia in an MSM population in Belgium identified three positive monkeypox patients who were completely asymptomatic at the time of collection and did not develop any subsequent symptoms.Monkeypox cases are being diagnosed mainly, but not exclusively, among MSM. 215 of the 218 confirmed cases in Brazil as of July 9 were male patients.

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