Mpox Genital Lesions: A Large Single-center Experience With Intermediate Follow-up

Since the Mpox (formerly known as Monkeypox virus) global outbreak, there have been limited reports on the clinical course and management of genital lesions related to Mpox infections. Genital lesions have been reported to manifest in almost 50% of patients infected with Mpox. We set out to describe the clinical manifestations, management, and outcomes of a large cohort of subjects undergoing treatment with tecovirimat with intermediate follow-up.

This was a retrospective case series of patients with genital Mpox lesions undergoing treatment with tecovirimat under the Centers for Disease Control and Prevention Emergency Authorization-Investigational protocol at a single, quaternary referral center. Fisher's exact tests were used to assess the association between Mpox-related genital skin changes and selected categorical variables.

A total of 68 subjects were included. The mean age was 34.9 years, and all participants were assigned male sex at birth. The mean follow-up period was 20.3 days. Management consisted of supportive care, antibiotic treatment for bacterial superinfection, medical debridement with collagenase for severe lesions. Urological consultation was obtained in 5 (7.4%) cases. Sixteen (23.5%) patients had significant penile skin changes at final follow-up, which was significantly associated with lesion size (P = .001). No subjects in this cohort required surgical interventions.

We report this large series of Mpox-related genital lesions in men undergoing treatment with tecovirimat. Urologists are not required for the routine diagnosis and treatment of these lesions, but are important in determining appropriate treatment for severe lesions.