Male genital lesions in monkeypox virus infection: a case series

Monkeypox virus (MPV) is a rare zoonotic infection caused by an orthopoxvirus. The sudden outbreak of more than 3000 MPV infection from 50 countries has led the WHO to declare the infection as an "evolving threat of moderate public health concern". Here, we describe a case series of two cases of the MPV with a similar onset of cutaneous lesions in the genital area but with different progression in 35 and 41-year-old males respectively. Both of our patients were reported heterosexual with a 10-day prior history of unprotected sexual activity with a sex worker. Case 1 was uncomplicated having rashes over the chest, back, arms, and legs along with the occurrence of fluid-filled painless vesicles which was managed with topical antibiotic cream and wound care using povidone-iodine dressing along with oral amoxicillin/clavulanic acid. On the contrary, case 2 had a progressive necrotic lesion, which spread from the root of the penis involving the foreskin despite supportive measures eventually requiring circumferential surgical debridement of the foreskin. Hence, given the current outbreak, we must consider the possibility of genital MPV in patients with suggestive lesions, anywhere on the body (including the genitals), added to an epidemiological link or history of intimate contact with individuals that may be at high risk for transmission.