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Sexual closeness is the most likely route of transmission in 95 per cent of <keyword id="7616951" type="General" weightage="20" keywordseo="Monkeypox" source="Orion">monkeypox</keyword> cases, according to a global case study series from across 16 countries. However, the virus can be transmitted by any close physical contact through large respiratory droplets and potentially through clothing and other surfaces, said researchers at <keyword id="1828955" type="General" weightage="80" keywordseo="queen-mary-university-of-london" source="Orion">Queen Mary University of London</keyword>. In the study, the team reported 528 infections diagnosed between April 27 and June 24, 2022, at 43 sites in 16 countries. The findings, published in the New England Journal of Medicine (NEJM), showed 95 per cent of the persons presented with a rash (with 64 per cent having less than 10 lesions), 73 per cent had anogenital lesions, and 41 per cent had mucosal lesions (with 54 having a single genital lesion). Overall, 98 per cent of the persons with <keyword id="6393040" type="General" weightage="20" keywordseo="Infection" source="Orion">infection</keyword> were gay or bisexual men, 75 per cent were white, and 41 per cent had human immunodeficiency virus infection. Common systemic features preceding the rash included fever (62 per cent), lethargy (41 per cent), myalgia (31 per cent), and headache (27 per cent); lymphadenopathy -- swelling of lymph nodes -- was also common (reported in 56 per cent). Concomitant sexually transmitted infections were reported in 109 of 377 persons (29 per cent) who were tested. Among the 23 persons with a clear exposure history, the median incubation period was 7 days. Monkeypox virus DNA was detected in 29 of the 32 persons in whom seminal fluid was analysed. In addition, the study also identified new clinical presentations in people with monkeypox, not recognised in current medical definitions of monkeypox. These symptoms include single genital lesions and sores on the mouth or anus. The clinical symptoms are similar to those of sexually transmitted infections (STIs) such as syphilis or herpes and can easily lead to misdiagnosis. In some people, anal and oral symptoms have led to people being admitted to hospital for management of pain and difficulties swallowing. It's important that these new clinical symptoms be recognised and healthcare professionals be educated on how to identify and manage the disease - misdiagnosis can slow detection and thus hinder efforts to control the spread of the virus, the team said. "We have shown that the current international case definitions need to be expanded to add symptoms that are not currently included, such as sores in the mouth, on the anal mucosa and single ulcers. These particular symptoms can be severe and have led to hospital admissions so it is important to make a diagnosis," said <keyword id="14521849" type="General" weightage="80" keywordseo="chloe-orkin" source="Orion">Chloe Orkin</keyword>, Professor of HIV Medicine at QMUL. "We have also found monkeypox virus in a large proportion of the semen samples tested from people with monkeypox. However, this may be incidental as we do not know that it is present at a high enough levels to facilitate sexual transmission. More work is needed to understand this better," added Dr John Thornhill, <keyword id="189594" type="General" weightage="80" keywordseo="consultant-physician" source="Orion">Consultant Physician</keyword> in Sexual Health. These findings will improve future diagnosis, help to slow the spread of infection and help the international community prioritise the limited global supply of monkeypox vaccines and treatments to communities most at risk, the researchers said. SEE ALSO: <a target="_blank" class="c-link c-message_attachment__title_link" href="https://www.businessinsider.in/education/news/cbse-class-12-results-declared-passing-rate-above-92/articleshow/93045586.cms">CBSE class 12 results declared, passing rate above 92%</a> <a target="_blank" class="c-link c-message_attachment__title_link" href="https://www.businessinsider.in/education/news/80-impact-students-going-to-study-abroad-will-feel-the-pinch-but-it-is-worse-for-students-already-there/articleshow/93044954.cms">₹80 impact: Students going to study abroad will feel the pinch, but it is worse for students already there</a>

Monkeypox: 95% spread occurred via sexual activity, says study

<ul class="summary-list"><li>A first-of-its kind study of <keyword id="13900629" type="UNKNOWN" weightage="60" keywordseo="monkeypox" source="Orion">monkeypox</keyword> patients around the world reveals some of the most common symptoms.</li><li>Some patients have only one single lesion, making it hard to diagnose the virus.</li></ul>A groundbreaking new study of more than 500 monkeypox cases diagnosed around the globe suggests the disease is being missed and misdiagnosed frequently, as testing and vaccinations lag. Case studies in the report, which come from roughly 100 different clinicians stationed around the world, reveal some of the most common symptoms of monkeypox in the current <keyword id="12784210" type="UNKNOWN" weightage="60" keywordseo="outbreak" source="Orion">outbreak</keyword> may not always line up with what people expect to see."Most people have never had any training on monkeypox," lead study author Chloe Orkin, a professor of HIV Medicine at Queen Mary University of London, told Insider. "The important thing is to help doctors to recognize it, so they don't mistake it for a sexually transmitted infection."Orkin's study, published in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2207323?query=featured_home">New England Journal of Medicine on Thursday</a>, found that among 528 monkeypox patients identified in 16 countries between April and June, rashes were common (occurring 95% of the time). Some 73% of patients had anogenital lesions, while roughly 10% of patients had only one monkeypox lesion visible on them. 98% of the patients, who all agreed to be in the study, were gay or bisexual men, reflecting the fact that much of the monkeypox transmission in this outbreak has happened during sexual contact.<h2>Some patients had trouble swallowing, or going to the toilet</h2><div type="image" title="a man being administered the monkeypox vaccine" height="1066" width="1600" msid="93039498" hostid="261" sizebytes="101252"></div>Cases ranged from very mild to so debilitatingly painful that it became impossible for the patients to use the toilet or swallow, Orkin said. "People weren't only presenting the skin problems," she added, which is different from how the virus has been characterized in past outbreaks. "They were also presenting with problems inside the anus and inside the mouth. And sometimes these problems were so serious that people were having to be admitted to hospital for pain."Symptoms of monkeypox infection that showed up before people developed a rash included fevers (in 62% of patients), lethargy (41% of the time), muscle aches (31%), and headaches (27%). Among 70 patients who were hospitalized from the study, the most common issues patients had were severe anorectal pain (21 patients), skin infections (18 patients), and <a href="https://www.insider.com/monkeypox-man-hospitalized-couldnt-swallow-spit-feared-death-symptoms-2022-7">trouble swallowing</a> (five patients).Early treatment is critical, not only to help contain the virus, but also because the antiviral treatments that are available work best when administered early on in the course of an infection. "It can easily be missed," Orkin said. "And it does look as though it has been missed."Dr. Lilian Abbo, from the University of Miami, expressed frustration during an <a href="https://affiliate.insider.com?u=https%3A%2F%2Fvimeo.com%2F729999731">Infectious Diseases Society of America phone call</a> last week that some patients in South Florida had to schedule multiple visits with different providers before they finally received a positive monkeypox diagnosis. At least 2,323 monkeypox cases have been diagnosed so far in the US, according to the <a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html">Centers for Disease Control and Prevention</a>, and the <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396">World Health Organization</a> estimates that monkeypox is present in at least 50 countries around the world. <div type="image" title="monkeypox lesions of different types" height="474" width="569" msid="93039500" hostid="261" sizebytes="22556"></div>Clinicians aren't sure whether the monkeypox that is circulating now is truly a different kind of virus than they've seen in the past, or whether the different presentations of the virus being seen now are more reflective of how monkeypox is being passed from person to person (through skin to skin touching during sexual contact.) Though monkeypox DNA was detected in the semen of some of the patients tested in this study, it's still unclear what that find might mean for potential sexual transmission of this virus."You can find virus in semen, but it doesn't necessarily mean that it's a <keyword id="6364896" type="UNKNOWN" weightage="60" keywordseo="public-health" source="Orion">public health</keyword> concern," Dr. Lawrence Purpura, an infectious disease expert at Columbia University Irving Medical Center, said.Purpura, who was not involved in this research and has studied viruses in semen including Ebola and COVID, said "just detecting a virus doesn't immediately raise the red flags that we should be worried about sexual transmission at this point, but it does, I think, give enough impetus to really study it — and study it quickly, to figure out if that is a potential risk."

Huge study of monkeypox patients reveals common symptoms, from fevers to small lesions

<ul class="summary-list"><li>Experts in San Francisco, Miami, and the UK say many monkeypox cases are being "missed."</li><li>Some patients are receiving false negative monkeypox tests, while others are being misdiagnosed.</li></ul>More than <a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html">7,100 monkeypox patients</a> have been diagnosed in the US since this outbreak began with a single case in mid-May.But Dr. Graham Walker, an emergency physician in San Francisco, says that many more monkeypox patients are not being given the care and attention they deserve to prevent, diagnose, and treat this infectious disease efficiently.Walker says he's seen "several patients" whose monkeypox diagnosis was "missed" by another provider before they landed in his ER in excruciating pain."I had a patient who, I saw their record from another facility, and it said, 'lesions only in the genitals, so unlikely to be monkeypox,'" he told Insider. Other clinicians and scientists in the US, the UK, and West Africa say the same: monkeypox is being widely underdiagnosed. <h2>Some misdiagnosed patients end up in so much pain they can't wear clothes</h2>Across the country from Walker's ER, Dr. Lilian Abbo, an infectious disease specialist at the University of Miami, says she's noticed the same issue. "We have seen patients that have been going up to seven centers: three different urgent cares, dermatologists, and ERs to try to figure out what is going on," she said during a recent Infectious Diseases Society of <a href="https://affiliate.insider.com?u=https%3A%2F%2Fvimeo.com%2F729999731%3Fsid%3Din%257C62d9a412884de613c421403c%257Cbrowser%26utm_campaign%3D3861930%26utm_source%3Daffiliate%26utm_channel%3Daffiliate%26cjevent%3Db9f54d9d14c111ed805a011f0a82b82d%26clickid%3Db9f54d9d14c111ed805a011f0a82b82d">America telebriefing</a>, stressing the need for better awareness of how monkeypox can present.Better awareness can have huge implications for both treatment, and disease containment. It's possible that if close contacts find out early enough in the course of their infection (meaning, in the first 4 days after an exposure) the Jynneos smallpox vaccine may be <a href="https://www.cdc.gov/poxvirus/monkeypox/considerations-for-monkeypox-vaccination.html">used to prevent monkeypox infection altogether</a>.But, "by the time they arrive," many patients who've been misdiagnosed "may have been healed, or some of them may have progression of disease," Abbo said. That progression can be painful. Patients in this outbreak have, in some of the most severe presentations, been unable to use the toilet, because the pain around their anus and genitals becomes so severe. "One of my patients said 'I can't even wear pants or underwear without pain,'" Walker said. <h2>'Textbook' descriptions of symptoms aren't always accurate</h2><div type="image" title="Matt Ford shows monkeypox spots" height="1000" width="2000" msid="93393933" hostid="261" sizebytes="90386"></div>Part of the reason why monkeypox is being underdiagnosed is that <a href="https://www.insider.com/monkeypox-miserable-experience-man-timeline-symptoms-vaccine-2022-7">this disease outbreak isn't operating</a> like the "textbook" monkeypox presentations of the past, with a classical fever, swollen lymph nodes in the neck, and headache all appearing before pox surface on the face and on the hands.Instead, monkeypox lesions may be lodged in the rectum, lymph node swelling may be present only in the groin, and it's not unusual for a single pock to be the only marker of a person's entire infection.A July 21 <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2207323?query=featured_home">New England Journal of Medicine</a> compilation of 528 case reports from 16 countries around the world establishes some clear patterns for this outbreak. Nearly two-thirds of the patients studied had lesions in their anogenital (private) area, with a majority of patients counting less than 10 lesions on their entire body.Patients were "presenting with symptoms that weren't part of the case definitions," NEJM study author Chloe Orkin told <a href="https://www.insider.com/monkeypox-symptoms-butt-pain-fevers-lethargy-lesions-2022-7">Insider</a>. "The important thing is to help doctors to recognize it."Fever, fatigue, muscle aches and headaches were some of the most common pre-rash signs a monkeypox infection was budding, which also makes it easy for people to confuse the condition with COVID, initially. "Every single patient I've talked to has done a COVID test when they had a fever, and they're like, 'oh, it's not COVID,'" Walker said. Other times, diagnoses are missed because providers don't get a "good, aggressive scrub" of the lesions, he said."I've seen that before, where people have had a test that came back negative and I'm like, 'you have literally every symptom of monkeypox, this looks exactly like all the other monkeypox cases I'm seeing, and we've ruled out other stuff, like herpes, syphilis, whatever.'" <h2>Some people avoid monkeypox diagnosis because it can be stigmatizing, painful, and lonely</h2>Early treatment is key to curb a monkeypox infection and prevent the excruciating pain it causes. The antiviral drug Tecovirimat (TPOXX) can help, as well as prescription painkillers which are stronger than Motrin and Advil.But many patients, fearing stigma and lacking information, are not seeking help.One of Walker's patients had been managing his lesions alone for two full weeks, when he finally decided to seek treatment. "He just wanted to manage it at home. He was worried about the stigma, he said he'd never had an STD before. But the pain was so severe, he finally came in," Walker explained. "There's lots of fear, there's lots of anxiety, and to be honest, there's probably a lot of people who aren't diagnosed yet," he added. Dr. Jason Zucker, an infectious disease specialist at New York Presbyterian hospital, said "even patients with mild disease have been taking it very hard" when they receive a monkeypox diagnosis."In addition to this stigma, patients who are diagnosed then isolate at home for up to four weeks alone," he told journalists on a Zoom call Friday. "It's important to make sure that we're all cognizant of this, that we all work together to reduce stigma, and that we offer patients mental health and other supportive resources after their diagnosis." <h2>A Nigerian doctor spotted this kind of monkeypox in 2017. He hopes people will finally start funding research on this virus.</h2>In Nigeria, where Dr. Dimie Ogoina has been studying monkeypox outbreaks linked to sexual contact <a href="https://pubmed.ncbi.nlm.nih.gov/29619921/">since 2017</a>, he says he's struggled with similar issues of confusion and stigma, which both make it harder to get a sense of the true scope of any outbreak.Often, he suspects, patients with "genital lesions" aren't coming to the hospital to be properly diagnosed, instead, they're just going to the pharmacy for STD treatment. "There are a lot of things that still not known about monkeypox" because "it has been a neglected disease," Ogoina told Insider. "Since the global north is now having cases, I'm sure there will be investments in research, and we will be able to uncover most of these unknowns."

An ER doctor says he's sick of seeing monkeypox patients misdiagnosed, only to end up in the hospital in excruciating pain

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Monkeypox: 95% spread occurred via sexual activity, says study

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Huge study of monkeypox patients reveals common symptoms, from fevers to small lesions

Hilary Brueck

An ER doctor says he's sick of seeing monkeypox patients misdiagnosed, only to end up in the hospital in excruciating pain

Hilary Brueck

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