photo of dr walker with scrubs, surgical mask on
Dr. Graham Walker, an emergency physician, treats monkeypox patients in San Francisco.Courtesy of Graham Walker
  • Many monkeypox cases are being missed by experts.

  • Some patients are getting negative monkeypox tests while others are not.

  • Fear, stigma, miscommunication and misunderstanding are some of the contributing factors.

There have been more than 7,000 cases of monkeypox in the US since May.

Many more monkeypox patients are not being given the care and attention they deserve to prevent, diagnose, and treat this infectious disease according to Dr. Graham Walker.

Several patients who were diagnosed with monkeypox were missed by another provider and ended up in Walker's ER.

He told Insider that he had a patient who hadles only in the genitals and that it was not likely to be monkeypox.

Monkeypox is being underdiagnosed in the US, the UK, and West Africa.

Some misdiagnosed patients end up in so much pain they can't wear clothes

The University of Miami's infectious disease specialist says she's seen the same problem across the country.

She stressed the need for better awareness during a recent Infectious Diseases Society of America telebriefing.

Disease containment can be affected by better awareness. If close contacts find out early that they have been exposed to monkeypox, the Jynneos vaccine may be used to prevent the disease.

Many patients who were misdiagnosed may have been healed by the time they arrived. It can be hard to progress.

Patients in the most severe presentations have been unable to use the toilet because of their pain.

'Textbook' descriptions of symptoms aren't always accurate

Matt Ford underestimated the pain from monkeypox.Matt Ford

This disease outbreak isn't like the "textbook" monkeypox presentations of the past, with a classical fever, swollen lymph nodes in the neck, and headaches all appearing before pox surface on the face and on the body.

It's not uncommon for a single pock to be the only marker of a person's entire disease.

The New England Journal of Medicine put together a collection of case reports from 16 countries around the world. Almost two-thirds of the patients had some kind of skin problem in their private area, with a majority of patients counting less than 10 skin problems on their whole body.

Patients were presenting with symptoms that weren't included in the case definitions. Helping doctors to see it is the most important thing.

It's easy for people to confuse a monkeypox infection with Covid when they first see the symptoms.

Walker said that every patient he has talked to has had a COVID test when they had a high temperature.

He said that providers don't get a good, aggressive scrub of the lesions can miss diagnoses.

"I've seen that before, where people have had a test that came back negative and I'm like, 'you have every symptom of monkeypox, this looks exactly like all the other monkeypox cases I'm seeing, and we've ruled out other stuff, like

Some people avoid monkeypox diagnosis because it can be stigmatizing, painful, and lonely

It's important to treat a monkeypox infection early so it doesn't cause as much pain. The prescription painkillers are stronger than Motrin and Advil and can help.

Many patients don't seek help because they don't want to be stigmatized and lack information.

One of Walker's patients decided to seek treatment after being alone for two weeks.

He wanted to take care of it at his house. He said he had never had an STD. The pain was so bad that he had to come in. There's a lot of fear, a lot of anxiety, and a lot of people who aren't diagnosed yet.

Even patients with mild disease have been taking it very hard when they get a monkeypox diagnosis.

Patients who are diagnosed are isolated for up to four weeks at a time. It's important that we are aware of this, that we work together to reduce stigma, and that we offer patients mental health and other supportive resources after their diagnosis.

A Nigerian doctor spotted this kind of monkeypox in 2017. He hopes people will finally start funding research on this virus.

In Nigeria, where Dr. Dimie Ogoina has been studying monkeypox outbreaks linked to sexual contact, he says he's struggled with the same issues of confusion and stigma, which make it harder to get a sense of the true scope of any outbreak.

He suspects that patients with genital lesions are just going to the pharmacy for STD treatment, rather than going to the hospital for a proper diagnosis.

Monkeypox has been neglected and there are a lot of things that are not known about it. We will be able to uncover most of the unknowns since the global north is now having cases.

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