Human monkeypox: diagnosis and management

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.

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 …