Introduction: Monkeypox (MPX) is a zoonotic virus, endemic to Central and Western Africa. Since early May 2022, there has been an outbreak of the virus with 3,548 confirmed cases in the UK for 2022, predominantly affecting men who have sex with men (MSM). Due to the virus’ capacity to transmit via exchange of bodily fluids, colonisation of the genitalia is not uncommon. Despite this, there is a paucity of available literature concerning urological manifestations. This case series seeks to elucidate the natural history of MPX from a urological perspective. Methods: We reviewed all MPX antigen-positive cases at Guy’s & St Thomas’ NHS Trust, and affiliated sexual health centres in south London, between May and October 2022. Patients that presented with penile lesions were identified — of those, cases that required specialist urological input were selected. Results: 199 men with Monkeypox were identified. Of those, 10% (19/199) presented with penile lesions and required treatment in an isolation ward with full personal protection equipment; 4% (8/199) required input from the urology team. Their average age was 41.6 (± 7.1) years. 62.5% (5/8) of these patients were HIV positive but only one was poorly controlled (>200 copies/mL). 75% (6/8) of patients experienced penile oedema and 50% (3/6) of these patients experienced paraphimosis. One patient experienced paraphimosis without oedema, another experienced penile cyanosis concomitant with severe distal oedema. Rarely, urinary insufficiency will develop. The average number of penile lesions was 6 (range: 1-14, s.d. ± 5.4). Lesions demonstrated a range of presentations — some initially appeared as pustules and papules, while more severe cases developed extensive, wet ulcerations; in some cases secondary infections were superimposed on the lesions, leading to necrosis. All lesions, however, were painful and required analgesia. On average, patients would present to health services 5.4 (± 1.6) days after onset of symptoms, and would take 21 (± 7.9) days for all lesions to heal. Conclusions: MPX urological presentations seem to observe a continuum of severity. Currently, the long-term urological sequelae of MPX are unknown but small lesions seem to heal without issue. By assessing the number of penile lesions and the presence of / potential for superimposed infections, a clinical picture for the course of the infection can be constructed and be used to inform management. SOURCE OF Funding: None
