A recent monkeypox case demonstrated a completely different clinical presentation from typical monkeypox, a medical report on the first monkeypox case in Korea said. It is said that most monkeypox cases are believed to occur due to close contact between homosexual, bisexual or other men who have sex with men.
A joint research team from the Korea Disease Control and Prevention Agency (KDCA) and Incheon Medical Center published the report on the first case of monkeypox in Korea in the Journal of Korean Medical Science (JKMS) on Tuesday.
According to the report, the first case of monkeypox occurred in a 34-year-old male who returned to Korea on June 21 from Germany. On arrival, he learned that his male friend in Germany – whom he stayed with for 14 days in Germany – had received a diagnostic test for monkeypox. So he alerted KDCA and Incheon airport about this during the arrival process. In a PCR test later, he was confirmed with monkeypox. He has been getting treatment at Incheon Medical Center.
The research team hypothesized that monkeypox might be spread by close contact during sexual activity. Earlier, British and American researchers raised a similar claim. This is because recent monkeypox cases showed a tendency to develop legions in the genitals or rectum instead of the typical rash in past monkeypox cases.
Most recent European cases revealed that the male patients had sex with men. Thus, the recent cases differ from those in endemic countries, the JKMS report said.
“The cases were mainly reported in homosexual, bisexual or other men who have sex with men,” according to the U.S. CDC’s early data analysis.
The Korean male patient showed similar symptoms. He is bisexual and has no relevant medical history. According to the report, he denied having sexual intercourse with anyone, including his male friend, or interactions with animals or animal carcasses during his trip.
On the first day of hospitalization, he had a penile ulcer with a diameter of 7mm. He reported no pain. Legions appeared in the oral cavity, but there were no blistering or pustular rashes. The patient was unaware of the lesions in the skin until he checked them on the day of arrival.
On the second day of hospitalization, the patient started having a chilling, sore throat and high fever – signs of the monkeypox prodrome. Then, on the fifth day in the hospital, an erythematous, maculopapular rash appeared on his upper back and spread all over his body.
“The initial presentation of a penile ulcer before prodrome in this case as well as the patient’s contact history also suggests that close contact during sexual exposure might have been the route of acquisition,” the research team said. “However, this theory warrants further research with a larger number of patients.”
The WHO also said there needs to be further research on this.
The research team noted that early symptoms of monkeypox could be similar to those of some sexually transmitted infections such as syphilis, herpes, or lymphogranuloma venereum.
In this case, the rash that occurred about four days after the fever was different from that of typical monkeypox and was similar to that of other viruses such as measles or noninfectious etiologies such as adverse drug reactions, according to the report.
“Therefore, careful history taking should be undertaken along with physical examination in the patients who have epidemiologic risk factors for monkeypox,” the research team emphasized.
As of Tuesday, global monkeypox cases reported 7,075.