Ulcerating vulvar lesions revealing a rare female case of monkeypox in Switzerland

The human monkeypox virus is a zoonotic orthopoxvirus initially discovered in Africa that causes a disease similar to smallpox with less severe symptoms. Since May 2022, the virus is being transmitted from human to human at an increasing rate outside of Africa. Although monkeypox infection was endemic in Africa, it had sporadic surges in recent years. This has led the World Health Organization to declare its highest alert level on July 25, 2022. In Switzerland only, 456 individuals have been diagnosed with monkeypox infection from May 19, 2022, to August 29, 2022. To date, >99% of patients with monkeypox infection are men, in particular those who have sex with other men. Clinical cases of women with monkeypox infection are still very rare but will more likely be seen. With this case, we have highlighted the fact that this zoonosis is also starting to spread among women. We have presented the case of a female patient living in Switzerland who presented to our gynecologic emergency department for painful vulvar lesions after an episode of upper respiratory tract infection. The monkeypox infection was confirmed with a real-time polymerase chain reaction analysis at the University Hospital of Geneva, a center of reference for monkeypox in Switzerland. Shortly after, the patient developed generalized and typical lesions on the whole body.