But in this current outbreak, many people's symptoms don't fit this profile at all, say Vinh and several doctors involved with these cases.
For starters, the rash often isn't on the face or extremities at all. Instead, it typically begins on the genitals or the anus. And sometimes it doesn't spread to other parts of the body.
"You don't have head-to-toe skin pox lesions," Vinh says. "Instead it's localized to just one region of the body, like the genital regions. And some people have just one or two pox. So it's not numerous."
"Sometimes it's not even a pox," he says, "but rather an ulcer or a crater."
But even if only a small part of the body is affected, monkeypox isn't necessarily a mild illness. "The rash can be really painful, and some patients have reported needing prescription pain medicine to manage that pain," says the CDC's Jennifer McQuiston. "The sores can also cause long term scarring on the skin."
And what about those flu-like symptoms? Sometimes they don't appear at all, Vinh and other doctors have found. Or they can appear after the skin lesions appear. Sometimes patients have a single swollen lymph node and sometimes they don't. Some patients have
inflammation of the rectum, infectious disease specialist Agam Rao, with the CDC,
told JAMA.
At one clinic in Montreal,
a patient with monkeypox had one tiny lesion on his penis which wasn't painful: "Never had other rash/lesion elsewhere. Never had [a] fever, " Dr. Sebastien Poulin, of the Clinique l'Agora, explained on Twitter.
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