FOUR cases of a new, more infectious version of mpox that first emerged in Congo have now been identified in the UK – and an expert has warned of one lesser-known symptom to look out for.
The UK cases mark the first time the mpox variant has caused a cluster of illness outside of Africa, although scientists said the risk to the public remains low.
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The clade Ib variant is a new form of the virus, different from clade II which spread globally in 2022.
It’s also been reported in Germany, Sweden, India and Thailand.
The main symptoms of mpox are flu-like symptoms such as a high fever, muscle and back aches, shivering, and fatigue.
Swollen glands that feel like new lumps, especially in the neck, armpits and groin can also occur.
The most common and notable symptom is the blistering rash that appears.
Dr Bruno Silvester Lopes, a lecturer in microbiology at Teesside University, explained: “People with mpox develop a blistering rash that usually appears one to five days after other symptoms develop, often starting on the face or genital area and spreading from there.
“The rash progresses through four stages: flat spots, raised spots, fluid-filled blisters, and then scabbing or crusting as it heals.”
But Dr Lopes warned of another, lesser-known symptom of mpox to look out for – proctitis.
Proctitis is inflammation of the rectum, the muscular tube that connects the colon and allows stools to pass out of the body.
According to research, it’s reported in 14 to 32.9 per cent of mpox cases, but its prevalence has increased since the 2022 global outbreak.
Symptoms of proctitis include:
- Rectal pain
- Diarrhoea or constipation
- Blood or mucus in stools
- Swelling or fullness in the rectum
- Tenesmus, or the constant feeling of needing to have a bowel movement
- Difficult or painful bowel movements
Dr Lopes also urged many of the symptoms of mpox could be easily missed.
He said: “People often miss the mild, flu-like symptoms, which include fatigue and muscle aches.
“A mild fever can resemble common viral infections, which leads to a delayed recognition.
“If they’re not painful, then swollen lymph nodes, such as enlarged glands in the neck, armpits, or groin, often go unnoticed.
“A small or isolated rash, particularly if it appears in less visible areas like the genital region, may be mistaken for another skin condition.
“Rectal inflammation may be confused with other gastrointestinal issues.
“These symptoms, especially if they occur without the classic mpox rash, can lead to delayed diagnosis and an increased chance of spread.”
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What should you do if you think you have symptoms?
If you think you have symptoms of mpox, you should:
- Isolate yourself: Avoid close contact with others to minimise spread.
- Contact a healthcare provider: Call your doctor or local health service for guidance on testing and next steps.
- Follow hygiene measures: Wash your hands frequently, avoid sharing personal items, and cover any rash if possible.
- Avoid touching rashes or blisters: Refrain from scratching to prevent further infection and minimise spread.
Symptoms typically last two to four weeks. Dr Lopes advised: “The rash progresses through stages during this time, with recovery usually occurring as the rash heals and scabs fall off.”
Mpox is contagious and can spread through close physical contact with someone who has symptoms, especially direct contact with their rash, blisters, body fluids, and through sex, said Dr Lopes.
He added: “Respiratory droplets passed through prolonged face-to-face contact spreads mpox, as well as contaminated items such as clothing, bedding, or towels used by an infected person.
“People are typically contagious from the onset of symptoms until their rash fully heals and scabs have fallen off.”
How should you treat symptoms?
Over-the-counter pain relievers like paracetamol or ibuprofen can reduce fever and alleviate body aches.
Keep the rash clean and covered to prevent infection, and avoid scratching to reduce the risk of scarring and further infection.
Dr Lopes recommended: “Drink plenty of fluids to stay hydrated, especially if experiencing fever or if the rash affects eating or drinking.
“Consult your GP to seek medical advice for specific treatment options, and to discuss the potential use of antiviral medications if symptoms are severe.
“Most importantly, follow isolation guidelines to prevent spreading the virus to others until you are no longer contagious.”
Can mpox develop into something serious?
Mpox can develop into serious conditions, particularly in certain immunocompromised individuals.
Potential complications include:
- Secondary infections, where bacterial infections can occur in lesions or blisters due to scratching or improper care.
- In rare cases, the infection can lead to systemic complications like sepsis, especially in immunocompromised individuals. Respiratory complications may arise if the virus spreads to the lungs.
- If lesions affect the eyes, it can lead to conjunctivitis or more severe eye conditions, potentially resulting in vision loss.
- The rash can leave long-term permanent scars if not properly managed.
- Pregnant individuals may experience complications, and there’s a risk of transmission to the foetus.
Dr Lopes added: “While most cases of mpox are mild, individuals with weakened immune systems, pregnant people, or those with underlying health conditions are at higher risk for severe complications.”
Who can get the mpox vaccine?
The NHS is offering the smallpox (MVA) vaccine to people who are most likely to be exposed to mpox.
People who are most likely to be exposed include:
- Gay, bisexual, or other men who have sex with men (GBMSM)
- Some health workers that work on infectious disease inpatient units and sexual health services
- Some health and aid workers travel to affected countries to work within mpox response or sites with active outbreaks
- Close contacts of confirmed cases
- The NHS mpox outbreak vaccination programme is currently only available in London and Greater Manchester, to people who live or travel to have sex there.
- Healthcare workers will usually be offered two doses of the vaccine.
- Men who are gay, bisexual or have sex with other men will be offered 2 doses of the vaccine. The 2nd dose will be offered from 2 to 3 months after the 1st dose.
- Your local NHS services will contact you when you can get your 2nd dose.
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