SHM Converge Scientific Abstract ePoster Gallery-Beyond the Positive Sti: Unmasking Mpox in a Case of Gonorrhea Coinfection

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This case report describes a 40-year-old man with HIV who presented with penile swelling, purulent discharge, fever, dysuria, fatigue, tender inguinal lymphadenopathy, and diffuse umbilicated pus-filled skin lesions. He had recently had a sexual encounter and had already taken acyclovir and self-administered ceftriaxone for presumed gonorrhea without improvement. Initial workup showed positive urine gonorrhea and penile discharge cultures that grew oral/genital flora, which raised concern for gonococcal infection and balanitis. Imaging showed penile and scrotal soft tissue swelling and bilateral inguinal lymphadenopathy. He improved after ceftriaxone, doxycycline, and fluconazole, but after discharge his orthopoxvirus PCR returned positive, confirming mpox.<br /><br />The report emphasizes that mpox often presents first with genital, anal, or oral lesions rather than the classic viral prodrome. Lesions typically progress from macules to papules, vesicles, and umbilicated pustules before crusting. Coinfections with sexually transmitted infections are common, occurring in up to 40% of cases, and can obscure diagnosis when symptoms overlap with gonorrhea, chlamydia, or syphilis. This can lead to anchoring bias and delayed isolation, testing, and public health reporting.<br /><br />Key takeaways for hospitalists include maintaining a high suspicion for mpox in patients with new rashes and systemic symptoms, especially those living with HIV; recognizing that STI coinfection is common; avoiding premature closure when gonorrhea/chlamydia tests are positive; and using comprehensive evaluation and targeted testing to identify one or more concurrent infections. The case highlights the need for timely recognition of atypical mpox presentations to reduce transmission and ensure appropriate management.

Asset Subtitle

CJ Hattori

Meta Tag

Author List Aaron Reyes, CJ Hattori, Karena P. Nguyen

Category Clinical Vignettes

Concept Mpox

Concept Sexually Transmitted Infection

Concept Genital Lesion

Concept Mucocutaneous Lesion

Concept Coinfection

Distinguished Non-Finalist

Presenter Organization UC San Diego School of Medicine

Presenting Author CJ Hattori

Track Adult

Keywords

mpox

orthopoxvirus

HIV

penile swelling

purulent discharge

inguinal lymphadenopathy

sexually transmitted infection coinfection

gonorrhea

umbilicated pustules

balanitis

Mpox

Sexually Transmitted Infection

Genital Lesion

Mucocutaneous Lesion

Coinfection