Intended for healthcare professionals

Practice Practice Pointer

Human monkeypox: diagnosis and management

BMJ 2023; 380 doi: (Published 06 February 2023) Cite this as: BMJ 2023;380:e073352
  1. Rania Mansour1,
  2. Angela Houston23,
  3. Azeem Majeed4,
  4. Yap Boum II5,
  5. Emmanuel Nakouné6,
  6. Mohammad S Razai7
  1. 1St George’s Hospital Medical School, St George’s University of London, London SW17 0RE, UK
  2. 2Clinical Infection Unit, St George’s Universities NHS Foundation Trust, UK
  3. 3Infection and Immunity Clinical Academic Group, St George’s University of London, UK
  4. 4Department of Primary Care and Public Health, Imperial College London, UK
  5. 5Epicentre, Médecins Sans Frontières, Yaoundé, Cameroon
  6. 6Institut Pasteur de Bangui, Bangui, Central African Republic
  7. 7Population Health Research Institute, St George’s University of London, UK
  1. Correspondence to: R Mansour m2007027{at}

What you need to know

  • Consider coinfections with monkeypox and other sexually transmitted infections among patients presenting with an acute rash or skin lesions and systemic symptoms

  • While it is safe to manage monkeypox patients virtually, they may need advice to maintain infection control measures and interventions to manage complications

  • A specialist infectious disease unit with access to novel antivirals such as tecovirimat and cidofovir should manage high risk patients

  • Healthcare workers should be aware of the stigma surrounding monkeypox, which may result in reduced health-seeking behaviours; healthcare staff should screen patients sensitively, using inclusive language to avoid alienating patients

A man in his 20s presented to his GP with three days of inguinal lymphadenopathy and multiple pruritic perianal lesions (fig 1). Most lesions were vesicular, but a few were ulcerated, causing proctitis. There were no other signs or symptoms. He had no drug allergies and took laxatives and analgesia (naproxen) to help pass stool. The patient identified as a man who had sex with men (MSM) and had had multiple sexual partners at a recent event. He lived with a housemate, who was not a sexual contact and was asymptomatic.

Fig 1

Pre-treatment vesicular and ulcerated perianal lesions.

Empirical acyclovir and flucloxacillin was started by his GP, and the patient was referred to the infectious diseases clinic, where viral swab testing and sexual health screening were performed. On confirmation of monkeypox diagnosis via PCR, the patient’s housemate was advised to relocate, self isolate, and get vaccinated against smallpox. The patient was advised on infection prevention and control, red flags, and protocols for reporting new findings. The patient was monitored at home, received two courses of anti-infective drugs, including aciclovir and co-amoxiclav. Once the lesions were healed, he was considered no longer infectious. The patient was advised to have a full sexual health screen and was followed …

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