Differences in mpox evaluation by clinical care site: practice patterns across an academic medical system during the 2022 epidemic

Abstract

Background Patients with suspected mpox presented to different venues for evaluation during the 2022 outbreak. We hypothesized that practice patterns may differ across venue of care. Methods We conducted an observational study of patients undergoing mpox testing between June 1, 2022 – December 15, 2022. We assessed concomitant STI testing, sexual history, and anogenital exam and a composite outcome of all three, stratified by site. Venue of care was defined as ED (emergency department or urgent care), ID (infectious disease clinic), or PCP (primary care or other outpatient clinic). Results Of 276 patients included, over half (62.7%) were evaluated in the ED. Sexual history, anogenital exam and STI testing were documented as performed at a higher rate in ID clinic compared to ED or PCP settings. STIs were diagnosed in 20.4% of patients diagnosed with mpox, and syphilis was the most common STI among patients diagnosed with mpox (17.5%). Patients evaluated in ID clinic had higher odds ratio of completing all three measures (aOR 3.6 [95% CI 1.4-9.3]) compared to PCP setting adjusted for age, gender and MSM status. Cisgender men who have sex with men, transgender males and transgender females had higher odds ratio of completing all three measures compared to cisgender females (aOR 4.0 [95% CI 1.9-8.4]) adjusted for age and venue of care. Conclusions Care varied across clinical sites. ID clinics performed a more thorough evaluation than other venues. Rates of STI coinfection were high. Syphilis was the most common STI. Efforts to standardize care are important to ensure optimal outcomes for patients.