Monkey pox

Monkey pox is caused by the monkey pox virus which is a part of the poxvirus family. Symptoms of monkey pox are similar to smallpox but milder. The virus was first discovered in 1957 and the first human case was reported in 1970 in the Democratic Republic of Congo. Since then the disease has been predominantly seen in West and Central Africa with an outbreak in the USA in 2003.

Since April 2022, there have been cases of monkey pox reported around the world. The first confirmed case of monkey pox in Sri Lanka was reported on 02 / 11/ 2022 in an overseas returnee.

Monkey pox could spread to anyone through close contact with lesions, body fluids and large respiratory droplets. The reports from other countries showed more cases among sexually active males predominantly in sexual networks of male sex.It is usually a self-limited disease with symptoms lasting from 2-4 weeks. Severe cases have been reported, and the case fatality rate has been around 3-6% in the recent past.

The incubation period of monkey pox is 3-17 days. During this time, a person does not have symptoms and may feel fine. The illness typically lasts 2-4 weeks. The severity of illness would depend upon the initial health of the individual and the route of exposure. The current outbreak is associated with milder disease and fewer deaths than previous outbreak.The disease is generally manifest as a new, rash that develops into vesicles and then pustules.

The rash may appear anywhere on the body, including palms, soles and the anogenital region. During the current global outbreak, lesions often occur in the genital and anorectal areas or in the mouth. The rash could be localized to a specific body site or be diffuse and may be the only symptom people experience. It could be as painful until the healing phase but could also be painless. Skin lesions may be deep-seated, firm or rubbery. The evolution of lesions progresses into different stages before scabbing. Patients could have associated fever and other symptoms such as chills, enlargement of lymph nodes, malaise, muscle pain or headache. Fever could occur before the rash but may occur after the rash or in some cases fever may not develop at all. Respiratory symptoms such as sore throat, nasal congestion, or cough could occur with the illness.People with low level of immunity may present with an unusual rash, including a whole-body involvement which may make diagnosis more challenging.

It is important that people be aware of the symptoms of monkey pox and how to prevent spread of the disease. Seeking medical advice as soon as someone develops symptoms suggestive of monkey pox, avoiding close contact with others until the proper diagnosis is made and avoiding close contact with individuals who have symptoms suggestive of monkey pox or confirmed as monkey pox are important measures to avoid the spread of the disease.The Sri Lanka College of Sexual Health and HIV Medicine has developed guidance for testing of monkey pox in sexual health clinics in Sri Lanka.

Dr Priyantha Weerasinghe

Consultant Venereologist
STD clinic Negombo