• Exposure, Epidemiologic Criteria
  • Sexual contact (e.g., oral, anal, vaginal) in the preceding 21 days
  • Household, sexual, or close physical contact with suspected or confirmed case
  • Travel to high-risk location   in the preceding 21 days
• Rash  
  • Solely anogenital or may appear on other areas like the hands, feet, chest, face, or mouth
  • Appears as pustules, papules, or vesicles
  • Evolves into scabs
  • May be painful or pruritic
• Prodrome
  • Fever, chills, headache, malaise, myalgia, lymphadenopathy
• CDC—Signs and Symptoms  

Exposure Screen

• Close contact (sexual, household) with person with suspected or confirmed case in preceding 21 days
• and
• Rash, fever/rash

• History
  • Symptoms, prodrome, rash
  • Exposure, Epidemiologic Criteria
    • Sexual contact (e.g., oral, anal, vaginal) in the preceding 21 days
    • Household, sexual, or close physical contact with suspected or confirmed case
    • Travel History  
  • Risk Factors for severe disease

• Physical
  • Gloves should be used for skin exam for all rashes
  • Don expanded precautions for physical exam, specimen collection
  • Perform thorough skin and mucosal (e.g., anal, vaginal, oral) examination for the characteristic rash visual diagnosis  
• Use of Chaperones During Sensitive Area Physical Examinations
• Differential Diagnosis

• Disposition
  • Patient Counseling
    • Discuss anticipatory symptom monitoring for rash, isolation
  • Indications for Vaccination

• Diagnostic Testing
  • Orthopoxvirus Testing
    • Specimen Collection, Ordering
  • Additional Testing, as indicated
    • HSV, syphilis, GC/CT, VZV, enterovirus, HIV
  • Review Differential Diagnosis
  • Rash Visual Diagnosis  

• Discharge
  • Patient Counseling
    • Isolation not indicated

• Discharge
  • Patient Counseling
    • Wear well-fitted mask
    • Isolate at home until cleared by Dept of Health
    • Isolation indicated
    • Follow-up with PCP for new or worsening symptoms, fever

• Treatment and Management
  • Indications for Vaccination
  • Symptomatic Management
  • Admission Considerations
• Patient Counseling
  • Isolation Guidance  
  • Wear well-fitted mask
  • Keep all skin lesions covered
  • Isolate at home until all skin lesion scabs fall off and new skin forms
  • Avoid contact, including sexual contact, with others
  • Follow-up PCP and Dept of Health for test results

• Positive Test
  • Children and families should be informed of positive results
  • Isolation Guidance  

• Patient Counseling
  • Isolation Guidance  
• Indications for Vaccination
  • Children, Close Contacts

• Consult and Admission Considerations
  • ID Consult Considerations
  • Admission Considerations
    • Negative pressure room
    • Expanded Precautions
    • ED Referral Considerations