The 2022 multinational clade II mpox virus outbreak raised significant concerns about the potential for long-term health consequences. Previously, little was known about persistent effects after acute illness. A recent cohort study, Long-Term Mpox Sequelae 11 to 18 Months After Acute Illness, characterizes these outcomes. Consequently, healthcare providers must understand the residual physical and psychosocial burden of this disease. This study demonstrates that persistent Mpox sequelae are common, even a year or more after initial infection.
Prevalence of Persistent Mpox Sequelae
The cohort study enrolled 154 participants previously diagnosed with mpox and 201 persons at risk who never contracted the disease. The results highlight a high rate of persistent issues. Specifically, 58% of the post-mpox participants reported at least one persistent sequelae 11 to 18 months following their acute diagnosis. This suggests that the infection is not always a self-limiting condition for a significant proportion of patients.
Appearance-related sequelae were the most frequent findings. In fact, 56% of post-mpox participants experienced effects related to appearance. This included persistent skin discoloration and scarring. Furthermore, most of these sequelae were localized; 51% occurred at two or fewer sites. Therefore, while widespread physical morbidity was limited, visible reminders of the illness were common.
Functional and Psychosocial Long-Term Mpox Sequelae
While appearance-related effects were prevalent, the study also identified persistent functional sequelae in 13% of post-mpox participants. Specifically, half (50%) of these individuals reported ongoing anorectal dysfunction. Additionally, 35% reported urinary dysfunction. Thus, functional impairments, particularly in the genitourinary and anorectal systems, require clinical monitoring.
Psychosocial and behavioral impacts were also assessed. Interestingly, the proportion of participants reporting increased psychobehavioral symptoms was generally similar between the post-mpox and no-mpox groups. However, post-mpox patients did report continued challenges. Nearly half (49%) cited ongoing difficulties with their social life, and 19% reported ongoing issues with sexual performance. Depression and anxiety are common among survivors, especially those with significant physical or social consequences. In addition, those who experienced complications like abscesses or superinfections during the acute phase had a significantly greater impairment of their quality of life and sexuality at 4-6 months.
Management and Clinical Considerations for Mpox Sequelae
The data clearly reinforces the need for long-term follow-up for mpox survivors. Clinicians should proactively screen for persistent physical and psychological issues. The most common physical issues include skin scarring, which can be atrophic and create cosmetic concerns, and ocular manifestations like corneal scarring, potentially leading to visual impairment.
Furthermore, early intervention is critical, especially for severe acute lesions. The authors suggest more aggressive monitoring and treatment, or early dermatology consultation, to mitigate the possibility of long-term scarring for lesions at or exceeding 2 cm in size. Managing anorectal and urinary functional issues requires a focused approach. While most cases are self-limiting, complications like secondary bacterial infections or central nervous system involvement can lead to more severe long-term problems, such as peripheral neuropathy or seizure disorders. Physicians must also screen for depression and social disruptions and refer patients for behavioral support as needed.
Frequently Asked Questions
Q1: What percentage of Mpox patients experience persistent sequelae after one year?
Approximately 58% of individuals diagnosed with mpox reported at least one persistent sequela 11 to 18 months after their acute illness, according to a recent cohort study. This finding highlights that long-term issues are highly prevalent.
Q2: What are the most common types of long-term physical issues reported?
The most common long-term physical issues are appearance-related, with 56% of post-mpox patients reporting scarring or persistent skin discoloration. Functional sequelae, such as ongoing anorectal (50% of those with functional issues) and urinary dysfunction (35%), were also noted in a smaller percentage (13%) of the overall cohort.
Q3: Did the study find a lasting psychological impact from Mpox?
The study found that the proportion of participants reporting an increase in psychobehavioral symptoms was generally similar between the mpox and no-mpox groups. However, post-mpox patients reported continued social and sexual challenges, with nearly half citing ongoing difficulties with their social life and 19% reporting issues with sexual performance.
References
- Cholli PA et al. Long-Term Mpox Sequelae 11 to 18 Months After Acute Illness : A Cohort Study in Two U.S. Cities. Ann Intern Med. 2026 Jan 20. doi: 10.7326/ANNALS-25-00036. PMID: 41554127.
- BMJ Best Practice. Mpox – Prognosis and Management Approach.
- NIH National Library of Medicine. Long-term Consequences of Mpox Infection: Clinical Outcomes, Quality of Life, and Patient Rehabilitation.
- NIH National Library of Medicine. Clinical spectrum and long-term outcomes of mpox: a cohort study spanning from acute infection to six-month follow-up.
- NIH National Library of Medicine. Prospective observational study on scar sequelae after MPOX infection: an analysis of 40 patients.
- MedPage Today. Post-Mpox Side Effects Persisted More Than a Year After Acute Infection.