Patel A, Bilinska J, Tam J C H et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ 2022; DOI: 10.1136/bmj-2022-072410.

...may be present with no other symptoms.

By July 2022, 1,735 cases of monkeypox had been identified in the UK, mostly in gay, bisexual or other men who have sex with men. Transmission between humans is mainly through respiratory droplets and direct contact with skin lesions but can also occur via fomites (inanimate objects such as skin cells, bedding and stethoscopes). Classical symptoms include fever, malaise and headache, followed by skin lesions predominantly affecting the face, feet and hands and mucous membranes.

This paper describes the clinical manifestations of monkeypox in 197 cases identified in an infectious diseases centre in South London in May and June 2022. Twenty-seven (13.7%) of the cases had oropharyngeal lesions and nine (4.6%) had tonsillar erythema, pustules, oedema or abscess. In contrast to the classic symptoms described, in one-third of cases, the mucocutaneous signs appeared before the onset of fever.

Most infections are self-limiting, with symptoms lasting 2-4 weeks. Neonates, children and the immunosuppressed are at higher risk of complications.