Monkeypox physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Bassel Almarie M.D.[2]


Depending on the stage of the disease, physical findings may include low-grade fever, enlarged lymph nodes (submental, submandibular, cervical, inguinal), and skin rash with typical progression: Macular (1-2 days), papular (1-2 days), vesicular (1-2 days), pustular (5-7 days), scabs (7-14 days)[1].

Physical Examination

Vital Signs

  • Low-grade fever (temperature, 100.8°F, 38.2°C)[2]
    • Fever before rash ​is a key characteristics to identifying monkeypox[1]


Skin lesions develop after the prodrome (early set of symptoms). The United States Centers for Disease Control and Prevention described following characteristics of lesions to identify monkeypox[1]:

  • Relatively the same size and same stage of development on a single site of the body
  • Well-circumscribed, deep seated, and often develop umbilication (resembles a dot on the top of the lesion)
  • Disseminated rash is centrifugal (more lesions on extremities, face) ​
  • Includes palms and soles​
  • often painful until the healing phase when they become itchy (crusts)

The skin lesions usually develop simultaneously as macular (1-2 days), then evolve to papular (1-2 days), vesicular (1-2 days), pustular (5-7 days), and finally scabs (7-14 days).



  • Inguinal lymphadenopathy
    • Lymph nodes may increase in size in seldom cases after sexual intercourse[3]
  • Signs of proctitis, or inflammation of the rectum[4][5]
    • Anal and rectal pain
    • Rectal bleeding
    • Malodorous, mucopurulent discharge


  1. 1.0 1.1 1.2 "Clinical Recognition | Monkeypox | Poxvirus | CDC". Retrieved 2022-06-15.
  2. Fleischauer AT, Kile JC, Davidson M, Fischer M, Karem KL, Teclaw R; et al. (2005). "Evaluation of human-to-human transmission of monkeypox from infected patients to health care workers". Clin Infect Dis. 40 (5): 689–94. doi:10.1086/427805. PMID 15714414.
  3. Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, Osborne JC, Rampling T, Beadsworth MB, Duncan CJ, Dunning J, Fletcher TE, Hunter ER, Jacobs M, Khoo SH, Newsholme W, Porter D, Porter RJ, Ratcliffe L, Schmid ML, Semple MG, Tunbridge AJ, Wingfield T, Price NM (May 2022). "Clinical features and management of human monkeypox: a retrospective observational study in the UK". [[]]. doi:10.1016/S1473-3099(22)00228-6. |access-date= requires |url= (help)
  4. Basgoz N, Brown CM, Smole SC, Madoff LC, Biddinger PD, Baugh JJ; et al. (2022). "Case 24-2022: A 31-Year-Old Man with Perianal and Penile Ulcers, Rectal Pain, and Rash". N Engl J Med. doi:10.1056/NEJMcpc2201244. PMID 35704401 Check |pmid= value (help).
  5. Harris E (2022). "What to Know About Monkeypox". JAMA. doi:10.1001/jama.2022.9499. PMID 35622356 Check |pmid= value (help).