Sexually-acquired genital manifestations of mpox in black-skin African patients: A case series

Abstract

Background

Genital mpox has been scarcely described in Central and West Africa where the disease is endemic. This study aimed to describe the clinical manifestations of genital mpox acquired through sexual contact in heterosexual African couples.

Methods

This was a case series of patients presenting with genital lesions associated or without febrile pustular or vesicular eruptions and confirmed with a positive PCR. Medical records of patients were scrutinized between March 2022 and December 2025 in three dermatology centres located either in Cameroon or Benin. Sociodemographic characteristics, clinical features, laboratory results, treatment, and outcomes were systematically documented.

Results

In total, nine cases of genital mpox from six heterosexual couples were documented. Patients’ median age was 35 years (IQR 31-42 years; range: 28–45 years). Two heterosexual partners were living with HIV with undetectable plasma viral loads. Sexual contact preceding genital lesions’ onset was reported in seven of 9 cases (78%). The incubation period ranged from 3 to 10 days. Clinical manifestations included vesicles, pustules, erosions, ulcerations, genital edema, umbilicated necrotic papules, and inguinal lymphadenopathy. The morphology of lesions varied from rounded/oval to arcuate and linear patterns. The recovery time ranged from 2 to 8 weeks, though longer for ulcerations. People living with HIV experienced severe presentations and prolonged recovery.

Conclusion

Genital manifestations of mpox on black skin are polymorphic and can present with atypical features. Mpox should be considered as a differential diagnosis of genital lesions following condomless sexual intercourse, particularly in endemic areas.