Recently, DocWire News Medical Lead Payal Kohli, MD, FACC, spoke about the current monkeypox outbreak sweeping the U.S.
Dr. Kohli spoke on common patient misconceptions regarding monkeypox, what a physician should do if their patient presents with symptoms of monkeypox, how people are underestimating the number of monkeypox cases, and what we can all do to get through this outbreak.
DocWire News: As a physician, what concerns you most about the monkeypox outbreak in the U.S.?
Dr. Payal Kohli: It’s been really alarming to me as a physician to see that for monkeypox, despite having all the tools in place, we had a known test. We had a vaccine that was effective. We had strategies to try to contain this knowing what we knew about the COVID-19 pandemic, and yet the outbreak has gotten so big. In a way it’s almost like the horse is out of the barn at this point.
What are some common misconceptions patients have about monkeypox?
I’ve been hearing a lot of things from my patients about monkeypox that aren’t necessarily true. So the first and biggest one that I want to clear up is that monkeypox is only a gay person’s disease. This was the mistake that we made with the HIV epidemic in the ’80s and now we have obviously so many heterosexual people infected with HIV. So similarly with monkeypox, anyone regardless of age, gender, sexual orientation, ethnicity can get monkeypox. I think because it has been spreading more efficiently in the homosexual community that has created a little bit of complacency in the heterosexual community where people think that they won’t be susceptible or may not be exposed. I would say that is probably the biggest misconception.
The other misconception that I’m hearing is that it’s like a chicken pox. In fact, it’s nothing like chicken pox. It’s a different family of viruses. The only reason they’re both called poxes is because they cause those lesions on the skin, the rash that looks like a pox, so to speak. But monkeypox actually belongs to the monkeypox family or the pox family of viruses of which smallpox is another member. That’s the other misconception that I’m hearing.
And then the third is that there’s no way to prevent monkeypox. And that’s another misconception because we do have a vaccine that’s pretty effective for monkeypox. If you’re someone who might be at high risk of exposure, or someone who’s already been exposed, you need to go and get that vaccine to reduce your risk of infection.
If you suspect one your patients has monkeypox, what steps should you take?
I haven’t come across this myself in the clinic yet, but if you encounter a patient in your office that you think might have monkeypox, first and foremost, you want to protect yourself. So you definitely want to make sure to wear a high-quality mask such as an N95 when you’re interacting with a patient. Of course, make sure you have enough PPE or personal protective equipment when you’re trying to culture the lesions. Because the next step in figuring out what’s going on with that patient is going to be, to actually send off a test and see if it’s monkeypox.
The way that you do that is you take one of the skin lesions. You unroof it, so you take off the top of the vesicle or the bulla there, and then you actually culture the base of the lesion and send that for a PCR test. There’s only a few specialized laboratories and a few commercial laboratories that actually do this. You’ll need to find out from your local government which lab in your area actually does do monkeypox PCR testing. You want to of course, place the patient under isolation, if they aren’t already.
And then you want to think about treatment. When that test comes back positive, there is a treatment for monkeypox. It’s called TPOXX, and it’s actually a treatment that was originally FDA approved for smallpox. The way to get it for monkeypox under compassionate use does require a little bit of paperwork, requires a consent form from your patient. You’re going to need to fill all that out to try to get your patient that therapy as soon as possible.
Given that we’re still in the COVID pandemic, is it possible that we may be underestimating monkeypox?
We are grossly underestimating the number of cases of monkeypox. I think that has a lot to do with the fact that we’re in the midst of a global pandemic with COVID. I also think it has to do with the challenges of actually doing the testing and having availability of the testing as well. It’s not an easy test to do and it’s not easy access to have this test.
And to give context in terms of how many cases we have, back in 2003 when we had a monkeypox outbreak in the United States, we had 47 cases. Here in 2022, we have nearly 12,000 cases that are already confirmed cases of monkeypox, and I suspect there are several hundred if not thousand more out there that are underdiagnosed. I think it’s really important to educate your patients and keep your radar up for monkeypox.
Now, most of the time it presents with that rash, that classic monkeypox rash that you can culture, but sometimes it can also present with fever and lymphadenopathy. If you have a patient who presents with tender lymphadenopathy, who maybe has not yet gotten their characteristic rash, your index or suspicion for monkeypox should be elevated in that particular setting.
What advice would you give to physicians and patients alike in getting through this outbreak?
I think the last two years have taught us so much about infectious disease, about how to protect ourselves but most importantly it’s taught us about the Ts, the importance of testing, the importance of treatment and the importance of prevention. I would say those are the lessons that we should take from COVID-19 pandemic and apply them to monkeypox as well as to future disease outbreaks that may exist.
I know we’re all tired. I know that there is immense fatigue when it comes to many of these infectious diseases because of the background of what’s happened, but don’t let your guard down either for yourself or for your patients, because it is going to be critically important to have all-hands-on-deck I think, as we think about coming out of the pandemic, coming out of this outbreak and really rebuilding and doing some damage control for our long-term preventive health.