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We appreciate the comments of Ya Bin Zhou on our Clinical Picture1 and agree that the diagnosis of monkeypox virus infection is indeed best achieved by detection of the virus in skin lesions.2, 3 In fact, in our patient, monkeypox virus DNA was detected by quantitative PCR in swabs taken from the oropharynx, rectum, and skin lesions. Since our Clinical Picture obviously did not focus on the diagnostic strategy or virus transmission of the case, we felt that the result of the skin swabs was not relevant. The main intention of 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 HIV-pre-exposure prophylaxis user who had been tested for HIV and syphilis with negative results directly before admission to, and right after discharge from, hospital.