From left: Darrell Tan, Sharon Sukhdeo, and Garfield Durrant

11 November 2025

By Betty Zou

A team of clinicians at Unity Health Toronto and the University of Toronto has created a new resource to help health care providers detect mpox earlier and to help patients get faster access to care and follow-up support.

The newly launched atlas currently contains over 60 images and is a curated, representative collection that more accurately captures what mpox lesions look like on people of different skin tones.

Collected during the 2022 outbreak, the images in the atlas come from participants in the Mpox Prospective Observational Cohort Study (MPOCS), one of several projects supported by the mpox rapid research response launched by U of T’s Emerging and Pandemic Infections Consortium and its hospital partners.

When mpox cases were first reported in Canada and the U.S. in 2022, community members and clinician-researchers like Sharon Sukhdeo were alarmed by the rapidly growing numbers in areas that had traditionally never seen mpox transmission. They were also concerned about the way in which the outbreak was portrayed in the media.

“We started seeing some pretty stigmatizing messages in the media about who is to blame, who is most commonly affected by mpox and where it came from. A lot of the images being used were only of Black skin, which was also stigmatizing and presented an untrue picture of the whole situation in 2022,” says Sukhdeo, who is an infectious diseases physician at Sinai Health and an assistant professor of medicine at U of T’s Temerty Faculty of Medicine.

The 2022 global outbreak and the recent mpox cases in Ontario predominantly affected the gay, bisexual and men who have sex with men (GBMSM) community, including GBMSM of all racial backgrounds.

Darrell Tan, an infectious diseases physician at Unity Health Toronto, credits community feedback for spurring him, Sukhdeo and their colleagues at Unity’s Knowledge Translation Program to create a freely accessible online image atlas of mpox lesions seen in the current outbreak.

“The very first time I thought about this issue was when a community member spoke about it at a community meeting about one week after we identified the first case in Ontario,” Tan recalls. He is also an associate professor of medicine at Temerty Medicine.

Garfield Durrant was the first to raise these concerns with Tan in May 2022. Durrant previously served as the lead men’s prevention specialist at the Black Coalition for AIDS Prevention and is now the director of HIV Prevention at the Ontario HIV Treatment Network.

“The launch of the online mpox image atlas represents a pivotal step in addressing the structural racism entrenched in early media portrayals of the virus,” says Durrant.

“The previous term, ‘monkeypox,’ perpetuated harmful stereotypes about Black and African individuals and was often used alongside anti-gay slurs, further stigmatizing already marginalized communities. These portrayals not only spread misinformation but also fueled stigma, complicating efforts to control the virus.”

With medical textbooks and references almost exclusively using images of mpox lesions on Black skin, physicians had a hard time diagnosing the disease, particularly because most of them had never encountered the virus before. They were also seeing lesions on different skin tones and with different clinical presentations like size and number.

“The lesions may look different from what you read about in the textbooks, and they may also differ from patient to patient. As a result, there were a lot of delays in diagnosis because doctors were not recognizing it, especially early on in 2022,” says Sukhdeo. She recounts stories of patients who were bounced around from one physician to another before finally receiving the right diagnosis and care.

“We saw an opportunity to not only change the narrative, but to correct it.”

Ontario reported 138 confirmed cases in the first nine months of 2025 and 291 in 2024, compared to 33 cases in 2023. As case numbers grow, researchers will add new images to the atlas. They will also make the resource available for patients, the general public and media to use.

“This project sets a new benchmark for inclusive and unbiased health communication by underscoring the importance of accurate representation. It’s vital for building trust with communities historically overlooked in public health narratives,” says Durrant.

“Images shape how we perceive health crises; and it’s crucial for journalists, media professionals and public health authorities to select images and narratives thoughtfully. I’m proud to be part of an initiative that challenges harmful stereotypes and works to ensure all communities are seen, heard and valued.”

The online atlas was created in collaboration with Unity Health Toronto’s Knowledge Translation Program.