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May 27, 2022
Since May 21, 2022, the World Health Organization (WHO), has reported >200 cases of non-endemic Monkeypox in 19 countries.1 In the United States, 9 orthopox virus cases have been identified, of which, five are confirmed to have Monkeypox (5/26/22).2 The majority of the cases identified, but not all, have been among men who have sex with men (MSM). Clinicians working in outpatient settings such as sexually transmitted infection (STI) clinics and urgent/acute care clinics have been identifying and diagnosing this disease.
Monkeypox is not easily transmitted. Transmission occurs via contact with body fluids and lesions, contact with contaminated items (i.e., clothing, bedding, surfaces, etc.), and exposure to respiratory secretions (including during aerosolizing procedures and agitation of clothing/bedding).3 The incubation period for monkeypox is 5–21 days (usually 6–13 days). Typically, symptoms start with a prodrome (fever, lymphadenopathy, and flu-like symptoms), followed by a deep-seated, umbilicated rash starting on the tongue progressing mainly to face and extremities (including palms and soles). The lesions evolve through stages—macular, papular, vesicular, pustular, and scab with recovery over days to weeks.4
The presentation of the current cases of Monkeypox have been atypical. It may be confused with other rash illnesses/STIs including Varicella Zoster, Chancroid, Lymphogranuloma venereum, or Syphilis. It is important to perform a comprehensive HPI, social history (travel and sexual history, and history of contact to others with similar rashes), and skin exam while being vigilant for identifying the following:5
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Travel to central or western Africa or to a country with recently identified cases (i.e., Europe, U.S., or Australia)
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Patient endorsing close contact with a confirmed case of Monkeypox
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Man who regularly has close or intimate in-person contact with other men, including those met through online website, digital application (“app”), at a bar, party, or public event
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Mild or absence of prodromal symptoms
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Genital and perianal lesions with or without proctitis
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With or without a rash found on other parts of the body
Monkeypox is infectious from the onset of prodromal symptoms and/or lesion formation until the scabs fall off with new skin formation. If you suspect a person has symptoms consistent with Monkeypox:
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Consider common pathogens first in your differential. Perform diagnostic tests for the more common pathogens based on history and exam (i.e., syphilis, chlamydia, HSV, VZV, etc.)
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For monkeypox, collect and correctly label 2 swabs from each of the lesions (sterile nylon, polyester, or Dacron tip with wood or aluminum shaft should be used and placed in sterile containers) for PCR testing.
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Notify the Lake County Health Department immediately (phone # 847-377-8130, select option 1) for assistance with testing, and potential treatment options, contact tracing, and post-exposure prophylaxis.
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Infection prevention is crucial.
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Healthcare personnel should wear a N-95 or higher filtration respirator, gown, gloves, and eye protection (i.e., face shield or goggles). Although this virus is not easily spread, healthcare workers should be afforded the highest level of protection.
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Clean and disinfect surfaces with EPA registered products.6
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Do not agitate bedding, clothing, or other soiled articles worn by the patient that may aerosolize the virus.
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Perform frequent hand hygiene.
Monkeypox training and information may be found at the WHO and CDC listed below.
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