Monkeypox symptoms 'different from past outbreaks'

Symptoms of monkeypox cases in the current outbreak are different from those identified in past cases of the disease, researchers have found.

Monkeypox vaccine
Monkeypox vaccine (Photo: Alain Jocard/Getty Images)

Pustules have been recognised as the main symptom of monkeypox cases in the past, but in the current outbreak 'rarer and more notable pseudo-pustules' are the main symptom, according to Spanish research.

The pseudo-pustules - which can lead to ulcers - are very rarely seen in other conditions and could help identify monkeypox cases more rapidly 

A review of 185 cases reported in Spain - 9% of all cases reported in the country by 11 July this year - identified differences in symptoms during the current outbreak.

Monkeypox symptoms

In the past, monkeypox symptoms have included fever and lymph node swelling followed by a 'generalised rash that progresses through four distinct phases', according to the study published in the British Journal of Dermatology.

Fever and swelling of lymph nodes remain common in the current outbreak, but skin lesions have been more limited and often appear only in a single area, the researchers found.

Most cases have started on the 'genitals, face, arms, hands, and perianal area' - and instead of the pus-filled lesions that characterise past cases, those in the current outbreak are 'pseudo-pustules' that look similar but are in fact 'whitish, solid papules' that do not contain pus.

Whereas the top layer of a real pustule can be scraped away to access the pus, this is not possible with pseudo-pustules, which can 'become necrotic and lead to ulcers'.


Researchers reported finding ulcers 'where the pseudo-pustules meet the moist, inner linings of body cavities such as the nose, the mouth, or the genital areas' as well as symptoms including 'monkeypox whitlow' - an infection of the finger - and a rash surrounded by inflammation.

They said the localised skin lesions identified in the current outbreak offer further evidence that sexual contact rather than airborne particles are a primary transmission route.

Research co-ordinator Dr Ignacio García Doval, from the Spanish Academy of Dermatology, said: 'Our research shows that the symptoms of the current outbreak are unusual and there is evidence that this is due to skin-to-skin contact during sex. Rather than the typical widespread rash seen in past cases, recent cases tend to have far fewer skin lesions, often in one location.

'It is particularly important for healthcare professionals to note the appearance of these skin lesions. Monkeypox is often described as causing pustules, pus-filled lesions, but in this outbreak, the main skin symptom is actually pseudo-pustules, white, solid papules which look like pustules, but which don’t contain any pus. This feature is very rare in other diseases, so is a very clear sign of monkeypox.'

Up to 25 July 2022, there were 2,367 confirmed and 65 highly probable monkeypox cases in the UK, according to the UK Health Security Agency. In England, the majority of cases have been in London, and the capital has accelerated its vaccine rollout in recent weeks targeting those at highest risk.

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