A 32-year-old man complained of itchy, painful lesions on the penis for 7 days. He reported mild fever, myalgia and malaise. The lesions started as a few white papulopustules, which gradually increased in number and size, coalesced and developed a central necrotic black crust and peripheral oedematous erythema (Figure 1). Bilateral inguinal lymphadenopathy with tenderness was noted. He had several episodes of homosexual sex during the previous 2 weeks. HIV-Ab, serological tests for syphilis and polymerase chain reaction (PCR) for herpes simplex virus were negative. The diagnosis of monkeypox was confirmed by PCR testing of the lesional contents. The patient was referred to the Infectious Diseases Clinic for further management.
A targoid lesion on the penis.
The monkeypox associated with the May 2022 outbreak is different from the ‘old’ monkeypox.1,2 The primary transmission mode is direct contact with infectious mucocutaneous sores or lesions, particularly during sexual activity.1 It occurs mainly in middle-aged men, especially men who have sex with men.1,2 The average incubation period is usually 7–10 days after exposure. The prodrome lasts 1–4 days, including fever, lymphadenopathy, malaise, myalgia and headache.1 Skin lesions usually begin in the oral or anogenital region, and some gradually progress to involve the trunk, limbs and face.1 However, lesions are generally localized in no more than 3 body regions and fewer than 20 in number.1,2 Lesions may present as various morphologies, but pseudopustule and targetoid lesions are characteristic cutaneous findings. The pseudopustule is a firm, deep-lying papule that mimics a pustule but does not contain fluid or pus, making it difficult to unroof with a swab. The targetoid lesions present as a pseudopustule with a central umbilicated necrotic black crust and peripheral oedematous erythema.1–4 Other common findings include oral lesions, pharyngitis, tonsillitis, proctitis and penile oedema.1,2 The diagnosis of monkeypox is made on the basis of epidemiological and clinical findings and is confirmed by nucleic acid testing.
Author contributions
Li-wen Zhang (Conceptualization [equal], Writing—original draft [equal]), Juan Wu (Conceptualization [equal], Tao Chen (Writing—review & editing [equal]), and Rong-Hua Xu (Writing—review & editing [equal])
This article has no funding source. The authors have no conflict of interest to declare. This content has not been published, nor has submitted for publication elsewhere. On behalf of all the contributors, I will act and guarantor and will correspond with the journal from this point onward. We hereby transfer, assign, or otherwise convey all copyright ownership, including all rights incidental thereto, exclusively to the journal, if such work is published by the journal.
The patient in this article has given written informed consent to the publication of their case details.
Conflict of interest
None declared.
References
Author notes
L.-W. Zhang and J.Wu contributed equally to this work.
