exclusively genital lesions from monkeypox

We don’t know today if monkeypox will become the next pandemic, but one of the factors favoring transmission and highlighted by the WHO is its sexual transmission (people who have multiple sexual relationships, especially between men). This is illustrated by the case of two 37-year-old men who had sex with men and presented exclusively with genital lesions from monkeypox, a far cry from historical descriptions of previous epidemics. The cases are detailed in an article published on J Travel Med by Dr. Benjamin Davido et al. described. [1]


The two 37-year-old men had both traveled to Europe, where they had unprotected sex in the days before the lesions appeared. One of them was on long-term treatment with PREP (HIV pre-exposure prophylaxis) and had a history of syphilis (treated 3 months ago). Both subjects complained of feeling feverish with localized lesions on the genitals without initial pharyngitis or lesions on the rest of the body suggestive of smallpox.


  • Absence of typical smallpox lesions, particularly no eruption of face, trunk, or extremities (palm or plantar involvement).

  • Examination of one of the patients revealed a lesion of the intergluteal sulcus.

  • One patient presented with lesions suggestive of genital herpes at an early stage and had documented gonococcal gonorrhea.

  • The lesions observed on the penis were of the macular punch type with a pseudo-“tentacular” appearance.

Additional exams

  • Imaging resolved a locoregional complication in 1 of 2 patients undergoing local impetiginization treated with antibiotics.

  • The 2 patients were confirmed by the CNR PCR orthopoxvirus on genital lesionsconfirmation of the Monkeypox Diagnosis.

treatment and aftercare

  • The 2 patients were isolated at home after diagnostic confirmation until the lesions disappeared (mean 21 days).

  • The entourage was contacted and monitored as recommended by the HCSP

What to remember

Suspicion of monkeypox can result in an atypical presentation, with only genital lesions requiring systematic full examination—the classic differential diagnosis is chickenpox, which, however, spares the palms and progresses to multiple outbreaks. The prevention of the disease goes as quickly as possible through its diagnosis, to examine the environment in case of suspicion and, if necessary, to offer vaccination.

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