enanthem in all patients ▪ Lesions in different phases of development seen side-by-side ▪ Rash either scattered or diffuse; sometimes limited to one body site and mucosal area (e.g., anogenital region or lips/face) ▪ Presenting complaint sometimes anorectal pain or tenesmus; physical examination yields visible lesions and proctitis ▪ Prodromal symptoms mild or not occurring ▪ Fever, lymphadenopathy not occurring in all patients ▪ Some co-infections with sexually transmitted infections (STIs) Lesions observed during May and June 2022* ▪ Firm, deep-seated, well-circumscribed, painful, itchy, sometimes umbilicated ▪ Small lesions; often not distributed diffusely ▪ May rapidly progress through stages (papules, vesicles, pustules, and scabs) ▪ Papulovesicular and pustular lesions may be seen on same body site For additional images: 1) Ogoina D et al. Clinical course and outcome of human monkeypox in Nigeria. Clin Infect Dis. 2020; 71(8): 210-214 2) Antinori A et al. Epidemiological, clinical, and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022. Euro Surveill. 2022 June; 27 (22). *As data continues to be collected, what is known about the clinical presentation may change Photos A and B from NHS England High Consequence Infectious Diseases Network; photo C from Reed KD, Melski JW, Graham MB et al. The detection of monkeypox in humans in the Western Hemisphere. Page 346. Copyright © 2004. Massachusetts Medical Society. Reprinted with permission More lesions observed during May and June 2022 Photo Credit: NHS England High Consequence Infectious Disease Network Monkeypox lesions, United States 2022 From Basgoz N, Brown CM, Smole SC, et al. Case 24-2022: A 31-Year-Old Man with Perianal and Penile Ulcers, Rectal Pain, and Rash. Epub ahead of print. Copyright © Jun 15 2022. Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society Shared with permission from patients, CDC 2022 CDC guidance to clinicians ▪ Perform thorough skin and mucosal (e.g., anal, vaginal, oral) exam for rash ▪ Obtain swabs if – Observation of classic monkeypox rash OR – Observation of rash that could be consistent with monkeypox in persons with epidemiologic risk factors: • Contact with a person or people a) with similar appearing rash or b) with diagnosis of monkeypox • Close or intimate in-person contact with people in a social network experiencing monkeypox activity (e.g., men who have sex with men who meet partners through an online website, digital app or social event) • History of recent international travel to country currently with many cases ▪ Diagnosis of STI does not rule-out co-infection with monkeypox ▪ Note: any person, irrespective of gender identity or sexual orientation, can acquire and spread monkeypox. Selected listing of current CDC priorities ▪ Understanding clusters and cases including risk factors to inform guidance ▪ Sequencing genomes of Monkeypox virus isolated from patients to monitor spread, variants, and track virus evolution ▪ Launching retrospective and prospective serosurveys to determine prevalence ▪ Refining case definitions based on data collected from clinics where cases are being detected ▪ Understanding natural history of current clinical presentation ▪ Expanding testing capacity at LRN laboratories and commercial laboratories ▪ Providing case-by-case consultations for clinicians considering treatment and post-exposure prophylaxis for patients Interim information and tools for healthcare providers and public health authorities www.cdc.gov/monkeypox ▪ Case definitions ▪ Clinical recognition ▪ Prevention strategies ▪ Exposure risk assessment ▪ Guidance for monitoring exposed persons ▪ Infection control in home and healthcare settings ▪ Specimen collection ▪ Considerations for medical countermeasures Topic of last presentation Topic of next presentation Centers for Disease Control and Prevention 2022 Monkeypox Case Study Leandro Mena, MD, MPH Director, Division of STD Prevention National Center for HIV/AIDS, Viral Hepatitis, STD and TB Control Centers for Disease Control and Prevention Clinician Outreach and Communication Activity (COCA) Call June 29, 2022 Thursday, June 2 – Day 1 ▪ The patient, a 26-year-old Hispanic MSM and an established client at a publicly funded STI clinic, presented for a routine 3-month HIV PrEP Clinic visit via telehealth ▪ He had no concerns during his telehealth visit ▪ He was instructed to come to clinic for his routine testing the next day Penile Lesions – Day 1 Of note: these lesions appeared after his morning telehealth visit Friday, June 3 – Day 2 – Patient History ▪ While self-collecting specimens for STI testing, the patient mentioned a rash on his penis that had started late the day before but had worsened since that time ▪ Additional history: • He had sex with 3 men at a sex party in NYC 05/29/2022 • He did not know whether any of these partners had recent travel • No international travel • No fever, swollen glands, or fatigue Friday, June 3 – Day 2 – Patient Exam Findings ▪ Genital exam • Uncircumcised; multiple discrete small papules and macules on the glans penis, coronal sulcus, and distal penile shaft • Some skin lesions were fleshcolored and some were pale; no pustules • Lesions were firm and slightly rubbery; could not