Observational Cohort Study of Evolving Epidemiologic, Clinical, and Virologic Features of Monkeypox in Southern France

Abstract

We enrolled 136 patients with laboratory-confirmed monkeypox during June 4–August 31, 2022, at the University Hospital Institute Méditerranée Infection in Marseille, France. The median patient age was 36 years (interquartile range 31–42 years). Of 136 patients, 125 (92%) were men who have sex with men, 15 (11%) reported previous smallpox vaccinations, and 21 (15.5%) were HIV-positive. The most frequent lesion locations were the genitals (68 patients, 53%), perianal region (65 patients, 49%), and oral/perioral area (22 patients, 17%). Lesion locations largely corresponded with the route of contamination. Most (68%) patients had isolated anal, genital, or oral lesions when they were first seen, including 56 (61%) who had > 1 positive site without a visible lesion. Concurrent sexually transmitted infections were diagnosed in 19 (15%) patients, and 7 patients (5%) were asymptomatic. We recommend vaccination campaigns, intensified testing for sexually transmitted infections, and increased contact tracing to control the ongoing monkeypox outbreak.

Monkeypox clinical disease: Literature review and a tool proposal for the monitoring of cases and contacts

“…In the first cases reported in 2022, skin rash was predominantly asynchronous and distributed in the pelvic, genital and perianal areas, while extra-inguinal lymph nodes were observed in less than 20% of cases [ 12 , 22 , 44 ]. Since then, series have highlighted the primarily occurrence of cases within the men who have sex with men (MSM) community (92–98%), and have confirmed the unusual prominent involvement of the anogenital region (33–94%) combined with an atypical or even absent invasive phase [ [17] , [18] , [19] , [20] , [46] , [47] , [48] , [49] , [50] ]. Notably, proctitis, as well as anal and rectal ulcers or fistula, with pain that may require intravenous morphine, were very evocative of MPX [ 17 , 18 , 46 , 51 , 52 ].…”

“…Since then, series have highlighted the primarily occurrence of cases within the men who have sex with men (MSM) community (92–98%), and have confirmed the unusual prominent involvement of the anogenital region (33–94%) combined with an atypical or even absent invasive phase [ [17] , [18] , [19] , [20] , [46] , [47] , [48] , [49] , [50] ]. Notably, proctitis, as well as anal and rectal ulcers or fistula, with pain that may require intravenous morphine, were very evocative of MPX [ 17 , 18 , 46 , 51 , 52 ]. Other highly prevalent conditions in current MPX cases include HIV infection (prevalence up to 52% in series), prior history of other sexually transmitted infections (STI), and multiple sexual partners [ 17 , 18 , 46 , 47 , 49 , [53] , [54] , [55] ].…”

“…Notably, proctitis, as well as anal and rectal ulcers or fistula, with pain that may require intravenous morphine, were very evocative of MPX [ 17 , 18 , 46 , 51 , 52 ]. Other highly prevalent conditions in current MPX cases include HIV infection (prevalence up to 52% in series), prior history of other sexually transmitted infections (STI), and multiple sexual partners [ 17 , 18 , 46 , 47 , 49 , [53] , [54] , [55] ]. The MPX disease most likely starts at the site of inoculation [ 13 , 14 , 20 , 46 ], so that the onset of the rash on the face is not an absolute rule [ 16 , 19 , 35 , [46] , [47] , [48] , [49] ].…”

“…Other highly prevalent conditions in current MPX cases include HIV infection (prevalence up to 52% in series), prior history of other sexually transmitted infections (STI), and multiple sexual partners [ 17 , 18 , 46 , 47 , 49 , [53] , [54] , [55] ]. The MPX disease most likely starts at the site of inoculation [ 13 , 14 , 20 , 46 ], so that the onset of the rash on the face is not an absolute rule [ 16 , 19 , 35 , [46] , [47] , [48] , [49] ]. Notably, initial or exclusive genital and/or anorectal rash was highly frequent in patients reporting receptive anal sex, supposing MPX acquisition through sexual contacts [ 11 , 12 , 17 , 40 , 41 , 44 , 46 , [56] , [57] , [58] , [59] , 59 ].…”

Gastrointestinal Manifestations of Monkeypox Infection: A systematic review and meta-analysis

“…Of the included studies, two studies were multinational [4,5], nine studies were from Spain [6][7][8][9][10][11][12][13][14], followed by seven studies from the United States of America [15][16][17][18][19][20][21], four from Congo [22][23][24][25], three from France [26][27][28] and Nigeria [29][30][31], and one each from Israel [32], Sudan [33], and the United Kingdom [34] (Table 1 ). The studies were comprised of 18 case series [5, 6, 9, 11, 12, 14, 15, 17-19, 21, 23, 25, 28, 29, 31, 32, 34], eight cross-sectional [4,7,8,16,20,22,30,33], and five cohort studies [10,13,24,26,27]. Additionally, studies were done on adult patients, pediatrics, and a mix of the two.…”