Monkeypox Disease with Predominant Genital Symptoms: A Nigerian Case Report

Abstract

Mpox presents typically with macular papular body rashes with similar-looking sores in genital or oral areas. It may be missed, or wrongly managed as sexually transmitted infections (STI), especially in settings where symptom-based treatment practices are sufficient for care.
 We describe a 40-year-old cisgender male, heterosexual Nigerian who developed some rash in the genital region associated with penile swelling. It was suspected to be syphilis and managed with presumptive antibiotics. Laboratory investigation (PCR) confirmed that it was a Mpox disease, and VDRLT was negative. Notably, in this case, the early symptoms were a paradigm case of Mpox disease presenting as an STI, which syndromically conformed more to an STI than the case definition for a suspected case of Mpox in our setting. Consequently, the expected early containment activities were delayed. This increased the potential of further disease spread. An Update of the standard case definition as well as a reclassification of the disease as a possible STI is recommended for enhanced surveillance, increased case detection, and reduction in the burden of unrecognized cases.

Viral emerging and re-emerging diseases: Basic understanding and future intervention strategies

“…Since human fluids that are contaminated with the virus may be present in wastewater, it is possible that MPXV can spread there. Therefore, public health officials' wastewater analysis can provide a clear picture of the scope of the Mpox outbreak and potentially aid in its containment (Ježek et al, 1988b;Nakoune et al, 2017;Adler et al, 2022;Ferré et al, 2022;Lu et al, 2022;Ogoina and Yinka-Ogunleye, 2022;Palich et al, 2022;Riopelle et al, 2022;Thornhill et al, 2022b;Owhonda et al, 2023;Wieder-Feinsod et al, 2023;CDC, 2023b,c).…”

“…Because infected skin lesions have the largest viral loads, the highest favorable rates, and the least invasive, quantitative real-time polymerase chain reaction (qPCR) techniques, have been suggested for detecting MPXV in these infected skin lesion swabs. These assessments are most effective when combined with clinical and epidemiological data, such as vaccination history (Ježek et al, 1988b;Adler et al, 2022;Lu et al, 2022;Ogoina and Yinka-Ogunleye, 2022;Palich et al, 2022;Riopelle et al, 2022;Thornhill et al, 2022b;Girón-Guzmán et al, 2023;La Rosa et al, 2023;Owhonda et al, 2023;Wieder-Feinsod et al, 2023;CDC, 2023b,c).…”

“…After the sickness first appears, the virus might shed for up to 3 weeks. However, it persisted longer in samples with cycle threshold (Ct) values higher than 35, lasting up to 8 weeks for semen and up to 10 weeks for saliva samples, and 6 to 10 weeks for respiratory samples (Ježek et al, 1986(Ježek et al, , 1988bNakoune et al, 2017;Ogoina et al, 2019;Vaughan et al, 2020;Adler et al, 2022;Ferré et al, 2022;Ogoina and Yinka-Ogunleye, 2022;Riopelle et al, 2022;Zachary and Shenoy, 2022;Thornhill et al, 2022b;Owhonda et al, 2023;Wieder-Feinsod et al, 2023).…”

Environmental detection and spreading of mpox in healthcare settings: a narrative review

“…After the sickness first appears, the virus might shed for up to 3 weeks. However, it persisted longer in samples with cycle threshold (Ct) values higher than 35, lasting up to 8 weeks for semen and up to 10 weeks for saliva samples, and 6 to 10 weeks for respiratory samples ( Ježek et al, 1986 , 1988b ; Nakoune et al, 2017 ; Ogoina et al, 2019 ; Vaughan et al, 2020 ; Adler et al, 2022 ; Ferré et al, 2022 ; Ogoina and Yinka-Ogunleye, 2022 ; Riopelle et al, 2022 ; Zachary and Shenoy, 2022 ; Thornhill et al, 2022b ; Owhonda et al, 2023 ; Wieder-Feinsod et al, 2023 ).…”

“…Since human fluids that are contaminated with the virus may be present in wastewater, it is possible that MPXV can spread there. Therefore, public health officials' wastewater analysis can provide a clear picture of the scope of the Mpox outbreak and potentially aid in its containment (Ježek et al, 1988b;Nakoune et al, 2017;Adler et al, 2022;Ferré et al, 2022;Lu et al, 2022;Ogoina and Yinka-Ogunleye, 2022;Palich et al, 2022;Riopelle et al, 2022;Thornhill et al, 2022b;Owhonda et al, 2023;Wieder-Feinsod et al, 2023;CDC, 2023b,c). The possibility of cross-border diffusion and subsequent transmission of Mpox has increased due to the ambiguity surrounding the outbreak's containment and the risk of social transmission.…”