Mpox Presenting as a Genital Ulcer

Summary: A 64-year-old male presented with a large genital ulcer two weeks after unprotected heterosexual intercourse. The ulcer presented as a large 10 x 8 cm group of 4-6mm fragile vesicles with central dells that evolved into superficial punched out ulcers. A polymerase chain reaction (PCR) swab of the genital ulcer was positive for orthopoxvirus DNA. Unlike in previous Mpox outbreaks, where lesions were mostly seen on the chest, hands and feet, a new Mpox strain causes milder symptoms and lesions on the genitals. Formerly known as monkeypox, the Mpox outbreak has prompted the World Health Organization to declare a global emergency (August 14th) to help curb the virus’ transmission. The Centers for Disease Control and Prevention has recorded more than 1,000 Mpox cases in the U.S. this year and a total of 32,063 cases since 2022 with 58 deaths. Mpox symptoms include fever, intense headache, lymphadenopathy, back pain, myalgia, and intense asthenia. The Mpox skin eruption stage lasts two to four weeks and includes lesions that evolve from macules to papules to vesicles to pustules, followed by scabs or crusts. This case demonstrates a Mpox virus clinical presentation of genital ulcer that may present in dermatology clinic as the virus spreads.