Mpox emerged as a public health crisis with limited research describing co-occurring HIV and sexually transmitted infections (STIs). We present a case of severe proctitis secondary to Mpox with concomitant HIV (Human Immunodeficiency Virus), syphilis, HSV (Herpes Simplex Virus), and chlamydia and review presentation, diagnosis, treatment, and prevention of Mpox with concurrent STIs.

Case Presentation:

34-year-old male living with HIV (LWH) presenting with worsening rectal pain, multiple anal papules, and fever. His laboratory workup revealed simultaneous positive results for orthopoxvirus, chlamydia, and HSV-1 PCR. We initiated tecovirimat due to rectal involvement and uncontrolled pain. He subsequently developed lesions on hands as rectal pain improved. He completed tecovirimat treatment and the lesions cleared by outpatient follow-up.


Among published studies of Mpox patients, 40% were LWH, and a significant percent were found to have co-occurring gonorrhea (23%), chlamydia (20%), syphilis (8%), and HSV (1%) with presentations including fever (62%), lymphadenopathy (49%), malaise (39%), and rectal pain (25%). We recommend Mpox and full STI diagnostic testing for unknown anogenital lesions and early treatment should be considered. Early initiation of Tecovirimat treatment should be considered in severe disease, immune deficiency, or those at high-risk for serious sequelae, in accordance with CDC guidelines.

Learning Points:

  • Identify the differential diagnosis for unknown rectal lesions
  • Describe the clinical presentation of Mpox
  • Summarize the diagnostic approach and interpretation of diagnostic results
  • Identify treatment options and considerations by patient populations
  • Review preventative strategies and high-risk populations for Mpox transmission



Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.