JU INSIGHT Mpox Genital Lesions: A Large Single-center Experience With Intermediate Follow-up
By: Justin Lee, MD, Columbia University Irving Medical Center, New York, New York; Jacob McLean, MD, Columbia University Irving Medical Center, New York, New York; Jason Zucker, MD, Columbia University Irving Medical Center, New York, New York; Steven Brandes, MD, Columbia University Irving Medical Center, New York, New York; Gregory Joice, MD, Columbia University Irving Medical Center, New York, New York | Posted on: 19 Sep 2023
Lee J, McLean J, Zucker J, Brandes S, Joice G. Mpox genital lesions: a large single-center experience with intermediate follow-up. J Urol. 2023;210(3):510-516.
Study Need and Importance
Since the Mpox (formerly known as Monkeypox virus) global outbreak in 2022, there have been limited reports on the clinical course and management of genital lesions related to Mpox infections. Urologists play an important role in the diagnosis and management of these genital lesions. Thus, there is a need for better understanding of the outcomes of these lesions.
What We Found
In our cohort of 68 subjects, the mean age was 34.9 years, all participants were assigned male sex at birth, and mean follow-up period was 20.3 days. Management included supportive care, antibiotic treatment for bacterial superinfection, and 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). An example of genital skin changes can be seen in the Figure. Importantly, no subjects in this cohort required surgical interventions.
There are several important limitations to mention for our study. One is that all patients were treated with tecovirimat with no control group available to directly compare to. Thus, our findings cannot be generalized to those not undergoing treatment with tecovirimat. Additionally, the follow-up period was 20.3 days, so long-term outcomes of these lesions and penile skin changes beyond this time period are not well understood.
Interpretation for Patient Care
Our study demonstrates that patients undergoing treatment with tecovirimat with genital lesions can be managed without need for surgical therapy. Urologists can consider debridement of severe genital lesions with topical collagenase. Finally, urologists can utilize these findings to guide management of Mpox lesions in the future.