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Individuals exposed to monkeypox during the recent global outbreak are exhibiting symptoms not typically related to the viral infection, according to a study published in the British Medical Journal (BMJ). The conclusions are based on 197 confirmed cases of monkeypox recorded between May and July 2022 at an infectious disease facility in London, UK.

Rectal soreness and penile swelling (oedema) are a couple of the typical symptoms they described, which differ from those mentioned in prior outbreaks, according to the researchers. They advise doctors to take monkeypox infection into account when treating patients who exhibit these symptoms.

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71 patients in all experienced rectal pain, 33 sore throats, 31 penile oedema, 27 oral lesions, 22 solitary lesions, and 9 enlarged tonsils.

The majority of patients (86%) reported having a systemic disease (affecting the entire body). The majority of systemic symptoms were fever (62%), enlarged lymph nodes (58%), and aches and pains in the muscles (32 per cent).

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Contrary to previous case reports that suggested systemic symptoms appeared before skin lesions, 38% of patients experienced systemic symptoms after the development of mucocutaneous lesions, while 14% had skin lesions without any other systemic symptoms.

According to the researchers, people who have large penile lesions or significant rectal pain from a confirmed monkeypox infection "should be considered for ongoing review or inpatient management".

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Each of the 197 participants in the study was a man (average age 38), and 196 of them identified as gay, bisexual, or having sex with other males. All of the patients had lesions on their skin or mucous membranes when they arrived, most frequently on the genitalia or in the perianal region.

The researchers noted that solitary lesions and swollen tonsils were not previously known to be typical features of monkeypox infection, and could be mistaken for other conditions.

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A little over a third (36%) of individuals also had HIV infection, and 32% of those who underwent screening for STIs had one, according to the researchers.

Twenty (10%) patients in all were hospitalised for the treatment of symptoms, most frequently rectal pain and penile swelling. There were no recorded fatalities, though, and no individuals needed acute medical care.

Only one participant had recently travelled to an endemic region, confirming ongoing transmission within the UK, and only a quarter of patients had known contact with someone with confirmed monkeypox infection, raising the possibility of transmission by people with no or very few symptoms.

The study authors acknowledge some limitations, such as the observational nature of the findings, the potential variability of clinical record keeping, and the fact that the data are limited to a single centre.

However, they said 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.

"Understanding these findings will have major implications for contact tracing, public health advice, and ongoing infection control and isolation measures," the researchers added.

(With PTI inputs)

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