More than half of adults evaluated 11 to 18 months after mpox diagnosis had at least 1 persistent physical sequela, most commonly mild appearance-related changes such as skin discoloration or scarring, according to a cohort study published in Annals of Internal Medicine.
Although most participants rated their overall health as good or better, many reported ongoing social and sexual effects, and 13% had functional complications, including anorectal and urinary symptoms.
The Life After Mpox (LAMP) study enrolled 154 adults with prior laboratory-confirmed mpox from clinics in New York City and Houston and assessed them a median of 15 months following acute illness. Clinicians rated 97% of participants' overall health as good or better, yet 58% had at least one persistent sequela and nearly half reported ongoing psychosocial challenges. The study was led by Preetam A. Cholli, MD, of the Centers for Disease Control and Prevention, and colleagues.
On clinician assessment, 58% of post-mpox participants had at least 1 persistent sequela. Most were appearance related (56%), typically limited in extent: among those with appearance-related sequelae, 51% had changes at 1 to 2 sites, 83% had persistent skin discoloration, and 51% had scars – with most reporting fewer than 10 scars or discrete pigmented areas.
Functional sequelae were reported in 13% of patients, most often involving anorectal or urinary dysfunction. Among those with functional sequelae, 50% reported difficulty defecating or stool incontinence and 35% reported urinary hesitancy or incontinence. A small number required procedural intervention following acute mpox infection, and some reported ongoing needs for assistive devices or ancillary services.
Beyond physical findings, 45% of participants reported increased depressive symptoms and 40% reported increased anhedonia. Nearly half of post-mpox participants reported ongoing challenges with social life, and nearly one in five reported ongoing effects on sexual performance. Participants with persistent appearance-related sequelae more often reported adverse effects on social life, while those with functional sequelae reported adverse effects on sexual performance nearly five times more often compared to those without functional sequelae.
By contrast, persistent sequelae were linked to markers of more severe acute disease. In multivariable analyses of acute severity components, having confluent lesions at least 2 cm in diameter was the only component independently associated with long-term appearance-related sequelae.
The study assessed whether persistent sequelae were associated with HIV control, vaccination, or antiviral treatment. Persistent physical sequelae were not independently associated with uncontrolled HIV (viral load ≥200 copies/mL), prior Modified Vaccinia Ankara–Bavarian Nordic (MVA-BN) vaccination, or tecovirimat treatment.
The researchers concluded that “post-mpox sequelae frequently persisted 11 to 18 months following acute mpox infection, with limited body distribution or physical morbidity but with continued social and sexual effects.” These results support longer-term follow-up after mpox, including assessment of persistent skin changes, anorectal or urinary symptoms, and ongoing social and sexual impacts.
Disclosures can be found in the study.
Source: Annals of Internal Medicine