January 23, 2026
2 min read
Key takeaways:
- Most patients diagnosed with mpox in 2022 had at least one persistent sequela months after acute illness.
- 56% of patients had appearance-related sequelae.
- 13% of patients had functional sequelae.
Almost six in 10 adults diagnosed with mpox during the 2022 outbreak had lingering physical symptoms for 11 to 18 months after acute illness, a study published in Annals of Internal Medicine showed.
According to Preetam A. Cholli, MD, a medical resident at Vanderbilt University, and colleagues, mpox remains an international public health threat, with WHO declaring public health emergencies in responses to outbreaks in 2022 and 2024. Yet the long-term physical, behavioral and psychosocial aftereffects of the clade II mpox virus, “and specifically clade IIb, have not been well documented,” they wrote.
Most patients diagnosed with mpox in 2022 had at least one persistent sequela months after acute illness. Image: Adobe Stock
The 2022 outbreak, which resulted in over 87,000 cases and 140 deaths in 111 nations — including the United States — was declared over in May 2023. Studies on this outbreak “correlated abscesses or superinfections during acute mpox with reduced quality of life or sexual performance 4 to 6 months later; scarring after 12 to 15 months; and clinical, virologic and immunologic data up to 24 months after mpox,” the researchers wrote.
In the current analysis, Cholli and colleagues assessed post-mpox sequelae among adults who attended HIV, HIV pre-exposure prophylaxis or sexually transmitted infection clinics in New York City or Houston and were either diagnosed with mpox from May 2022 to January 2023 (n = 154) or were at risk for, but never diagnosed with, mpox (n = 201).
All the patients completed psychosocial and behavioral self-assessments, while those diagnosed with mpox were physically examined by a clinician.
The researchers noted the proportion of patients reporting increased psychobehavioral symptoms was generally similar between the two groups.
They found that 58% of patients who had experienced mpox had at least one persistent sequela 11 to 18 months after acute illness. They added that 56% had appearance-related sequelae, but most had “fewer than 10 scars or sites of discoloration and two or fewer body sites involved.”
Cholli and colleagues wrote that having confluent acute mpox lesions sized 2 cm or larger was the only component of the Mpox Severity Scoring System tied to any long-term sequelae in their multivariable analysis.
Thus, “clinicians should consider more aggressive monitoring and treatment or early dermatology consultation to try to mitigate the possibility of long-term scarring for lesions at or exceeding 2 cm in size,” they wrote.
The researchers also reported that 13% patients had functional sequelae, among whom 50% had ongoing anorectal disfunction and 35% had ongoing urinary dysfunction. Only 2% reported that their activities of daily living were affected.
“Notably, a few participants had undergone an interventional procedure to treat mpox sequelae or still required assistive devices, underscoring some patients’ needs for more intensive medical management,” the researchers wrote.
But they added that almost 90% of participants who had mpox rated their health as good, very good or excellent at the time of the study’s evaluation “and only a few post-mpox participants had ongoing needs requiring use of health services at that time.”
Cholli and colleagues acknowledged that the study only enrolled participants in two regions of the U.S., meaning the findings may not be generalizable to the country’s entire population.
Additionally, the analysis “may have been too small to detect some associations between acute symptoms, persistent sequelae and other outcomes,” they wrote.
The researchers concluded the data still “provide informative context for characterizing the types of, and risk for, persistent physical and psychosocial sequelae” that may follow mpox.
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