The case study report, published in the Journal of Infection, says a 36-year-old Italian man developed a fever, sore throat and fatigue after returning from a trip to Spain earlier this summer where he had unprotected sex.
He first tested positive for COVID on July 2 and the following day began showing signs of a rash and lesions on his torso, face, glutes and lower limbs.
By July 5 the rash had spread further, at which point he sought treatment at an Italian hospital, where it was determined by testing that he had contracted monkeypox.
According to the report, the man was also tested for a range of sexually transmitted infections, including an HIV test that came back positive.
It’s the first time the three viruses have been diagnosed at the same time.
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The study’s authors said that monkeypox and COVID often share overlapping symptoms including fever, sore throat and headache which make it “difficult for physicians to perform the correct diagnosis, also considering that not all patients with monkeypox develop skin lesions and that COVID-19 may rarely present with rash and vesicles (spots).”
It’s too early to know whether the virus combination will result in a worse outcome for the patient, the authors wrote, but they are warning that there is no widely available treatment in the event that they co-occur.
The man, who was double vaccinated against COVID, told doctors he had been treated for syphilis in 2019 and had returned a negative HIV test in 2021.
A key takeaway recommended by the study’s authors is that doctors should consider a patient’s previous medical history, travel history and sexual activity when investigating diseases that have overlapping or similar symptoms.
“Our case emphasizes that sexual intercourse could be the predominant way of transmission. Therefore, complete STI screening is recommended after a diagnosis of monkeypox,” they wrote.
The paper says that since January of this year, more than 16,000 people in 74 countries have been affected by monkeypox and that the COVID subvariants BA.4 and BA.5 are currently responsible for more than a million coronavirus cases worldwide per day.