QWhat is monkeypox?

A
Cynthia Trickett, PA-C, MPAS

Cynthia Trickett, PA-C, MPAS

Medically reviewed on 9.1.2022 by Mark Lebwohl, MD

Monkeypox is a viral infection caused by the monkeypox virus, which is in the same family as the smallpox virus. In the past, most cases found in Central and West Africa but monkeypox is now a concern in the United States. Humans, animals, and materials infected with the virus can spread it to others. Typically it presents with fever, and then 1 to 3 days later, an unexplained eruption. Monkeypox lesions can have multiple morphologies but will most commonly start as a macules that progress to a pustules, then to vesicles. Other symptoms that the patient may present include chills, myalgia, headache, and lymphadenopathy. Since this virus may be transmitted sexually, it is important to ask about genital or anal lesions. 

What questions should I ask if I suspect monkeypox? 

  • Have you had contact with person/s with monkeypox? 
  • Do you have a fever? 
  • Do you have open sores or “pus bumps” on your body or in your genital area? 
  • Do you have swollen lymph nodes or lumps on your neck, underarms or groin? 

What testing should be done? 

The gold standard for diagnosing monkeypox is through a viral PCR test via SWAB of an active lesion. A biopsy of tissue is much less specific and not recommended as a definitive test. If monkeypox is only in the macular stage, a viral swab may not render a positive diagnosis. It would be best to inform the patient to return when there is a pustule, vesicle, or ulcer to swab. Deroof any pustule or vesicle before taking a sample. Most experts recommend at least two viral swabs from two different sites. While most commercial labs do have monkeypox testing, please ensure to visit the website of your state health department, especially for patient’s without insurance. 

If at all possible, have the patient remain in their vehicle to collect the sample. Dress in full protective gear, including an N95 mask. If a patient with suspected monkeypox is in an exam room, dress in full protective gear, have the patient wear a mask at all time, and disinfect the room after the patient departs, including all touched surfaces (including door handles if necessary). 

References:

  1. World Health Organization who.int/monkeypox 19 May 2022:1-3 
  2. Sorin V, Corral O.  International outbreak of monkeypox in men having sex with men.  AIDS Rev. 7 June 2022. DOI: 10.24875
  3. CDC Aug 26, 2022.  Preparation and Collection of Specimens.  Cdc.gov/poxvirus/monkeypox/clinicians/prep-collection-specimens.html