Case 16. Mpox After the Outbreak
Download MP3A 33-year-old man with HIV presents with a flu-like syndrome and a disseminated vesicular rash after sexual contact with a new partner. Differential diagnosis includes mpox, syphilis, other STIs, HSV and disseminated VZV. Listen as Eileen and her guest, Dr. Shauna Gunaratne work through the mpox diagnosis, and discuss the 2022 mpox outbreak, along with evidence-based recommendations for testing, treatment, and prevention.
References Cited:
References Cited:
- Akter F, Hasan TB, Alam F, et al. Effect of prior immunisation with smallpox vaccine for protection against human Mpox: A systematic review. Rev Med Virol. 2023 Jul;33(4):e2444. Epub 2023 Mar 30. PMID: 36999223.
- CDC. Monkeypox. Tecovirimat (TPOXX) for Treatment of Monkeypox. Available at https://www.cdc.gov/monkeypox/hcp/clinical-care/tecovirimat.html
- Dalton AF, Diallo AO, Chard AN, et al. Estimated Effectiveness of JYNNEOS Vaccine in Preventing Mpox: A Multijurisdictional Case-Control Study - United States, August 19, 2022-March 31, 2023. MMWR Morb Mortal Wkly Rep. 2023 May 19;72(20):553-558. PMID: 37200229.
- Mitjà O, Alemany A, Marks M, et al. Mpox in people with advanced HIV infection: a global case series. Lancet. 2023 Mar 18;401(10380):939-949. Epub 2023 Feb 21. Erratum in: Lancet. 2023 Apr 8;401(10383):1158. doi: 10.1016/S0140-6736(23)00584-6. PMID: 36828001.
- PALM007 Writing Group; Ali R, Alonga J, Biampata JL, et al. Tecovirimat for Clade I MPXV Infection in the Democratic Republic of Congo. N Engl J Med. 2025 Apr 17;392(15):1484-1496. PMID: 40239067.
- Titanji BK, Eick-Cost A, Partan ES, et al. Effectiveness of Smallpox Vaccination to Prevent Mpox in Military Personnel. N Engl J Med. 2023 Sep 21;389(12):1147-1148. PMID: 37733313.
Related Guidelines and Guidance:
- New York State Department of Health AIDS Institute Clinical Guidelines Program:
- Prevention and Treatment of Mpox
- Immunizations for Adults With HIV > Mpox
- Management of IRIS
- Doxycycline Post-Exposure Prophylaxis to Prevent Bacterial Sexually Transmitted Infections
- Guidance: Adopting a Patient-Centered Approach to Sexual Health
- GOALS Framework for Sexual History Taking in Primary Care
Resources:
- CDC Guidelines for Collecting and Handling Specimens for Mpox Testing
- NYSDOH Guidance on Testing at Commercial and Public Health Laboratories
Creators and Guests
Host
Christopher Hoffmann, MD, MSC, MPH
Dr. Hoffmann is an Associate Professor of Medicine in the Division of Infectious Diseases at Johns Hopkins, where he provides care for adults with HIV and general infectious diseases. His research focuses on improving HIV and TB outcomes in low- and middle-income settings, primarily in Southern Africa.
Host
Eileen Scully, MD, PhD
Dr. Scully is an Associate Professor of Medicine in the Division of Infectious Diseases at Johns Hopkins, where her clinical work focuses on inpatient and outpatient care of people with HIV. She serves on the Department for Health and Human Services Antiretroviral Guidelines Panel and also leads a lab focused on the immunopathogenesis of HIV and the impact of sex on immune responses to viral infections.
