Monkeypox physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Bassel Almarie, M.D.

Physical Examination

Vital Signs

• Low-grade fever (temperature, 100.8°F, 38.2°C)
  • Fever before rash ​is a key characteristics to identifying monkeypox

Skin

Skin lesions develop after the prodrome (early set of symptoms). The United States Centers for Disease Control and Prevention described with following characteristics of lesions to identify monkeypox:

• Relatively the same size and same stage of development on a single site of the body
• Well-circumscribed, deep seated, and often develop umbilication (resembles a dot on the top of the lesion)
• Disseminated rash is centrifugal (more lesions on extremities, face) ​
• Includes palms and soles​
• often painful until the healing phase when they become itchy (crusts)

The skin lesions usually develop simultaneously as macular (1-2 days), then evolve to papular (1-2 days), vesicular (1-2 days), pustular (5-7 days), and finally scabs (7-14 days).

Neck

• Lymphadenopathy (submental, submandibular, cervical)

Genitourinary

• A pelvic/adnexal mass may be palpated
• Inflamed mucosa
• Clear/(color), foul-smelling/odorless penile/vaginal discharge

^{Write additional pathognomonic findings, such as discharge that resembles cottage cheese for C. albicans vulvovaginitis / fish-odor for T. vaginalis ifnection}