As researchers and public health officials learn more about monkeypox, they have discovered new symptoms which may indicate the infection. The UK Health Security Agency (UKHSA) has updated its case definition of monkeypox to include these symptoms. 

The new symptoms health care practitioners have identified consist of one or more lesions on the genitals, anus or surrounding area, or mouth, and of anal or rectal pain or bleeding. Health professionals note that these symptoms should be watched for especially if one has recently engaged with a new sexual partner. 

British case definitions have been updated “to reflect the clinical presentations that have been seen during this outbreak,” said Meera Chand, Director of Clinical and Emerging Infections at UKHSA.

The updates affect the UK’s definitions of ‘possible’ and ‘probable’ cases of monkeypox. Factors considered indicators of a ‘possible’ case include contact with a confirmed monkeypox case within three weeks of the onset of “febrile prodrome,” a variety of flu-like symptoms, and “an illness where the clinician has a suspicion of monkeypox.” The “illness” to which this definition refers now includes lesions and anal or rectal pain or bleeding. 

A patient would count as a probable case as per the UK definition should they have an unexplained rash or lesion anywhere on their body or anal or rectal pain or bleeding, as well as any one of four other factors:

• Linked to a confirmed or probable monkeypox case within three weeks of symptoms beginning
• Has engaged in sexual relations with at least one new partner in the three weeks prior to the onset of symptoms
• Identifies as gay, bisexual, or a man who has sex with men (MSM)
• Was in Central or West Africa in the three weeks before symptoms began

The new symptoms were additionally included in results from an observational study conducted internationally and published July 21 in the New England Journal of Medicine (NEJM).

The study additionally reported the symptoms already acknowledged widely as potential indicators of monkeypox, including a fever, swollen lymph nodes, lethargy, head and body aches, and most commonly, a rash. The monkeypox rash tends to develop on the face, hands, feet, mouth or genital area of a patient, and goes through a few different stages before forming scabs and falling off. 

Monkeypox infections tend to be fairly mild, but can be more severe, to the extent that they might require hospitalisation. 13 percent of patients in the NEJM study, which observed 528 infections, were hospitalised. 

Symptoms can last two to four weeks, appearing within six and 13 days of exposure, according to PinkNews. The infection spreads through close contact, seemingly often through sexual contact. The healthcare professional in 95% of the cases evaluated in the NEJM study speculated transmission had occurred through sexual contact. 

Nonetheless, monkeypox is not a sexually transmitted infection (STI), a note that the NEJM researchers were careful to make, as its symptoms can appear similar to those of some common STIs. The researchers advised caution among medical practitioners when diagnosing STIs, lest they misdiagnose monkeypox and fail to stop its spread. 

Of the patients in the NEJM study, 98% were gay or bisexual men. The study stated explicitly, however, that “Although the current outbreak is disproportionately affecting gay or bisexual men and other men who have sex with men, monkeypox is no more a ‘gay disease’ than it is an ‘African disease.’ It can affect anyone.”

As of July 21, 2,208 cases of Monkeypox had been reported in the UK, with no deaths having occurred as of July 25. 69 cases had been reported in Ireland as of July 22. 

ACT UP Dublin last week called upon the Irish government to begin rolling out vaccines to help prevent the spread of monkeypox, and HIV Ireland issued a similar statement today, July 26. The latter organisation “is calling on the Government to meet ‘head on’ the challenges posed by rising levels of monkeypox in Ireland.”

In the wake of WHO declaring the virus a public health emergency, Prof Paddy Mallon, a HIV Ireland Board Member and Consultant in Infections Diseases at St Vincent’s University Hospital, said: “That the WHO has now designated monkeypox as a public health emergency of international concern underlines the seriousness with which this current widespread outbreak should be viewed.

“In Ireland, key priorities must include increasing awareness within the community in general about the signs and symptoms of monkeypox, accurate information on how it can be transmitted, and expanding access to testing and increasing availability of vaccination, which remain key components to the control and hopefully eradication of this infection,” he added.

Ahead of a virtual monkeypox community discussion organised by MPOWER, Man2Man and GCN, MPOWER’s Programme Manager Adam Shanley also stated: “We have done a lot of heavy lifting informing gay and bisexual men about monkeypox, however there are tools known to be effective in preventing onward transmission that we don’t yet have access to. As gay and bisexual men, we have a long history and strong legacy of banding together in times of adversity, and our community discussion is an example of that – we are mobilising our peers in the face of this new challenge.

“We have an opportunity to contain the spread of monkeypox, but it requires an immediate coordinated vaccination programme that prioritises those in our community most at risk of acquiring the virus,” he continued.

In a recent positive development, the European Medicines Agency approved a Danish monkeypox vaccine for use across the EU. Bavarian Nordic, the biotech company responsible for the Imvanex jab, announced the news over Twitter on Friday, July 22.

The National Immunisation Advisory Committee (NIAC) of Ireland had previously recommended a smallpox vaccine be used for monkeypox, and the Irish government purchased doses of smallpox vaccines specifically for this use. The HPSC is offering the vaccine to “high or intermediate risk contacts of monkeypox cases identified by the public health teams through contact tracing.”

“There is still a need to be cautious, stay alert for symptoms,” Chand said. For those in the UK, she said that anyone who thinks they may have monkeypox should contact 111 or a local sexual health service while remaining at home. 

Ireland’s Health Protection Surveillance Centre has issued similar guidance, advising people to contact their general practitioner or a sexual health clinic for advice should they suspect they may be infected with monkeypox while keeping their distance from others in the meantime. 

If you’re looking for more information on monkeypox and Ireland’s response, ‘Monkeypox Outbreak – A Community Discussion‘ takes place from 6pm on Wednesday, July 27 through GCN’s Facebook and YouTube channels. During the event, viewers will be able to ask questions, which leading public health professionals will be on hand to answer. Men who have been infected by the virus will also be sharing their lived experiences and advice will be offered to those concerned.