The link below has a bunch of terrible pictures of the effects of Monkeypox on gay males' penises and butts. It should be really be posted everywhere in gay communities to try to lessen the amount of orgies.
Some quotes:
Abstract
Objective To characterise the clinical features of monkeypox infection in humans.
Design Descriptive case series.
Setting A regional high consequences infectious disease centre with associated primary and secondary care referrals, and affiliated sexual health centres in south London between May and July 2022.
Participants 197 patients with polymerase chain reaction confirmed monkeypox infection.
Results The median age of participants was 38 years. All 197 participants were men, and 196 identified as gay, bisexual, or other men who have sex with men. All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%). 170 (86.3%) participants reported systemic illness. The most common systemic symptoms were fever (n=122, 61.9%), lymphadenopathy (114, 57.9%), and myalgia (n=62, 31.5%). 102/166 (61.5%) developed systemic features before the onset of mucocutaneous manifestations and 64 (38.5%) after (n=4 unknown). 27 (13.7%) presented exclusively with mucocutaneous manifestations without systemic features. 71 (36.0%) reported rectal pain, 33 (16.8%) sore throat, and 31 (15.7%) penile oedema. 27 (13.7%) had oral lesions and 9 (4.6%) had tonsillar signs. 70/195 (35.9%) participants had concomitant HIV infection. 56 (31.5%) of those screened for sexually transmitted infections had a concomitant sexually transmitted infection. Overall, 20 (10.2%) participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling.
Conclusions These findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries. A variable temporal association was observed between mucocutaneous and systemic features, suggesting a new clinical course to the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile oedema. These presentations should be included in public health messaging to aid early diagnosis and reduce onward transmission.
HIV and sexual health
Seventy of the 197 (35.5%) participants had HIV-1 co-infection (n=2 unknown). Sixty four (91.4%) of these participants were receiving antiretroviral therapy (n=4 unknown) (
table 3). Fifty five (78.6%) had an undetectable HIV-1 viral load (<200 copies/mL) (n=13 unknown). The median CD4 count was 664 cells/Ī¼L (interquartile range 522-894 cells/Ī¼L) (n=40 unknown).
People requiring hospital admission
Twenty five (12.7%) participants were admitted to hospital, of whom 20 (10.2% of the total cohort) were admitted for clinical reasons. The remainder were admitted for containment as they were unable to effectively self-isolate at home.
The most common clinical reasons for admission were perianal or rectal pain (8/20 participants) and penile swelling (5/20). Three participants had perianal or groin abscesses. Two participants had tonsillar abscesses. Two participants required ophthalmology review owing to eye involvement. Urinary retention, superimposed bacterial lower respiratory tract infection, and disseminated lesions in the context of immunocompromise occurred in one patient each. Of 20 participants admitted to hospital for clinical reasons, 15 (75.0%) had HIV co-infection. Three (15.0%) of the admitted participants were considered to have immunosuppression due to either HIV or immunosuppressive treatment.
Rectal perforation
Overall, 71 (36.0%) participants reported rectal pain or pain on defecation, and this was a common reason for admission (n=
. Five participants had proctitis confirmed on MRI, with one having a perforated rectum and one a perianal abscess.
One participant, a 46-year-old man with a history of HIV (viral load <200 copies/mL on antiretroviral therapy, CD4 count 1200 cells/Ī¼L), presented with severe rectal pain.
Symptoms started with fever, sore throat, and fatigue, followed by severe rectal pain. He was seen in the sexual health service, started on empirical doxycycline for proctitis, and tested for monkeypox virus. Over the next two days the patient developed a papular rash on his upper arms and trunk. A week after symptom onset, the rectal pain became so severe the patient required admission to hospital for pain control.
Oropharyngeal manifestations
Twenty seven (13.7%) participants had oropharyngeal lesions and nine (4.6%) had tonsillar erythema, pustules, oedema, or abscess.
One participant, a 25-year-old man, presented with a right sided tonsillar abscess.
He described developing right sided neck pain, quickly followed by an erythematous, pruritic rash over his trunk. He subsequently developed fever, progressively worsening right submandibular swelling, and pain, and he reported fatigue. The swelling increased, resulting in dysphagia and difficulty breathing.
Confluent lesions
One participant, a 40-year-old man with a history of HIV (viral load <200 copies/mL on antiretroviral therapy, CD4 count >500 cells/Ī¼L), first presented with vesicular lesions at the base of his penis that he had attributed to shaving. He then developed a fever, cervical lymphadenopathy, headache, fatigue, and loss of appetite. He subsequently developed lesions on his face, hands, torso, thighs, and penile shaft (
fig 8). Oral flucloxacillin was started because of the erythema around the lesions. The genital lesions progressed from vesicles to pustules, which in the next five days scabbed over. The scabbed lesions then coalesced and ulcerated, with substantial yellow purulent exudate. On day 8 of symptom onset the patient presented to the emergency department and was discharged owing to no clinical concern. He was admitted to hospital three days later for pain management, wound care, and treatment of presumed secondary bacterial infection.
Conclusions
These findings confirm the ongoing unprecedented community transmission among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries. Urgent research is needed to further understand the modes of transmission of monkeypox virus, particularly around sexual contact, and also the possibility of asymptomatic spread. We have highlighted new clinical presentations and shown photographs to assist clinicians in the diagnosis of monkeypox infection.
Rectal pain and penile oedema were the most common presentations requiring hospital admission in this cohort, yet these symptoms are not currently included in public health messaging. We recommend clinicians consider monkeypox infection in those presenting with these symptoms. Those with confirmed monkeypox infection with extensive penile lesions or severe rectal pain should be considered for ongoing review or inpatient management. The variable temporal association between mucocutaneous and systemic features, presence of solitary lesions, and biphasic appearance of lesions represent a variation from the classic features.
The continued growth of this outbreak means that spread to vulnerable populations is possible, including immunocompromised individuals and children, and the implications of this are not yet understood. Nosocomial transmission is an infrequent but avoidable consequence of unrecognised monkeypox infection in patients admitted to hospital.
1328 Disseminating awareness of atypical presentations is of vital clinical importance as failure to recognise monkeypox infection as a possible differential could pose a major risk to healthcare professionals and other contacts. Continued research will impact local and national infection control and isolation policies and guide the development of new diagnostics, treatments, and preventive measures. It is vital that as these research efforts continue, the populations that are already affected in endemic regions with higher reported mortality secondary to monkeypox infections are not excluded from the development and implementation of these interventions.
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