Skin lesion specimens as first choice to detect monkeypox virus Authors' reply

our short contribution was to show the ultrastructural presentation of an mpox infection of the colon, which is distinct from the presentation in the skin and that, to our knowledge, has not been shown previously. Proctitis and severe anal pain are now known to be frequently observed symptoms of mpox in the affected population, but they differ from symptoms previously described for the disease in the medical literature.3 At the time of admission to hospital, the severe anal pain of our patient required anorectoscopy and subsequent tissue extraction from anal ulcerating lesions was essential to exclude other differential diagnoses including neoplasms. Although we fully agree with Zhou that it is of utmost importance to investigate patients with mpox for other sexually transmitted diseases, the patient in our case was an had been tested for HIV and syphilis with negative results directly before admission to, and right after discharge from, hospital. lauem@rki.de