This article has been written by Michelle Forcier, MD and clinically reviewed by Kate Steinle, MSN, WHNP-BC.
With the Biden administration officially declaring monkeypox (MPX) a public health emergency, there is understandably a lot of anxiety about the virus with increased cases in the LGBTQ+ community. The recent outbreak of MPX alongside the ongoing COVID-19 pandemic—and in the shadow of the AIDS epidemic—is enough to make anyone feel anxious. But at the end of the day, MPX is a just virus and we want to equip you with the information you need to protect yourself and others against it.
We understand that there have been concerns and criticism of the racist connotations of the word “monkeypox.” The World Health Organization (WHO) is working on a new name for the virus, and we will update this article as soon as a new name has been decided upon. For now, we will be using the name monkeypox as well as the acronyms MPX and MPXV to refer to the virus interchangeably, as we want to make sure our information still reaches people who might not have access to the most recent updates.
What is monkeypox, and how does it spread?
Monkeypox virus (MPXV) is a virus like the common cold, COVID-19, or herpes. Like many other viruses, MPX can cause a self-limited infection that goes away over time. It may make you feel ill and give you a rash, but most people recover from this infection after about two to four weeks. People who are immunocompromised, have other serious medical issues, or are pregnant might be more seriously affected.
Viruses spread in many different ways. We think that MPX spreads through skin-to-skin contact such as people living closely together in the same household, sharing a bed, cuddling, or having sex. It seems as though MPX is also spread through sexual direct contact, not just through the body’s skin, but also through the mucous membranes of the mouth, anus, or vagina. During sex, body parts rubbing together create small areas of skin trauma or microabrasions of mucous membranes– these are potential entryways for the virus. It is not known at this time if MPX can be spread through semen or vaginal fluids, although viral DNA has been found in some semen and vaginal fluid samples of infected people.
It can also potentially be spread by fomites, or infectious particles in linens, towels, sheets, and sex toys. Because of this, it’s not advised to shake out linens used by an infected person, as that might shake infectious particles into the air. MPXV can also be potentially spread during face-to-face contact by respiratory droplets. Wearing a mask is always a good idea to prevent sharing or getting respiratory droplet infection exposure.
Less common ways that MPXV spreads are through an animal bite and contact with an infected animal’s body fluids. It also can be acquired by eating raw or minimally processed meat of an infected animal. MPXV can be transmitted from parent to child through the placenta.
How can I protect myself from monkeypox?
At present, people should avoid close contact with people exposed to or currently infected with monkeypox. If someone you know has MPXV, they should isolate from others at home. If they need to go out to see a health care provider, they should wear a mask and clothing to cover their rash and any lesions. People who have monkeypox symptoms ideally should not be sexually active with others while infected.
People who have been exposed to MPXV should monitor for symptoms for 21 days after exposure. If you don’t develop symptoms but had close contact with someone with MPX, you can go about your daily activities. If symptoms develop, you should immediately self-isolate and contact the health department for further guidance. If you want to speak with a FOLX clinician about your symptoms, or just get more information about what you can do to stay safe, you can make a virtual primary care appointment.
Maintaining physical distance and avoiding skin-to-skin or respiratory droplet contact with people exposed to or known to have MPX seems to help reduce your risk. People in households with someone self-isolating from MPX can use masks and gloves during interactions with the infected person, use good hand washing, and take care when handling laundry or soiled clothing. Keeping pets separate from the infected person may also help.
I’ve been exposed to someone with monkeypox. What should I do?
The incubation period—the time between exposure and showing symptoms—is typically five to13 days, but can range anywhere from four to 21 days. If you are exposed, you should watch for symptoms for 21 days. Most people with MPX infections show symptoms. People infected suffer an early prodromal period before the classic rash. This early period’s symptoms might include fever, fatigue, muscle and back muscle aches, headaches, and swollen lymph nodes. The rash usually starts one to four days after the fever and may last for two to three weeks. It develops on the face and then on the palms of the hands and soles of the feet and can look like pimples, blisters, or lesions. The rash may be found in other parts of the body such as the mouth, eyes, anus, and genitals. The MPX rashes tend to be painful and itchy.
If you’ve been exposed, keep an eye on your symptoms. You can go about daily activities, but maybe hold off on a lot of close physical contact with family and sexual partners. Let other people know you have been exposed as well, so they can be cautious. If you’ve not developed symptoms within 21 days after your last exposure, you did not get MPX from that contact.
I have monkeypox symptoms. What should I do?
Most people who get MPX don’t feel very well and have a painful itchy rash over a three-to-four-week period. As the infection begins to clear itself, the rash crusts over, and the scabs fall off. This part usually happens seven to 14 days after the rash starts. People can be considered no longer infectious when all the scabs have fallen off and there is new healthy skin formed where the rash, blister, or lesion was.
Most people get through MPX infection somewhat easily and can also decrease the outbreak by self-isolating comfortably at home. People who are hospitalized, more seriously ill, or at risk for more serious impact from the infection might require an antiviral medication. These people include children less than eight years old; pregnant and breast/chestfeeding people; immunocompromised people; and people already in the hospital due to complications of MPX. Some health officials think that people with infections involving the eyes, mouth, and genitals also should get antivirals. Decisions about treatment are made in conjunction with local health departments. The Centers for Disease Control and Prevention (CDC) will also continue to offer recommendations.
The antiviral medication used for treating MPX in more risky situations is called tecovirimat. It was approved for treating the smallpox virus (a relative of MPXV) and likely helps block the formation of infectious particles needed to spread. Tecovirimat is currently only available through the CDC. There are also eye drops called trifluorodine and vidarabine that might help if MPX lesions affect the eye.
For people with significant exposure and who are at high risk for more severe diseases, there are vaccines that can help. Post-exposure vaccination needs to be done in consultation with the local health department. The CDC says that at present the vaccine is mostly restricted to certain high-risk geographical and social communities, including cisgender gay men, bisexual men, and some transgender and non-binary people.
If in the last 14 days you have had sex with a person diagnosed with MPXV or sex with lots of partners in a community where there are a lot of MPX infections—you might be eligible for vaccination. Vaccination is thought to both prevent infection as well as decrease symptoms of the disease. At present, the main vaccine used in the US is Ankara (MVA) vaccine. It is FDA approved for both smallpox and MPX. It is given in two doses 4 weeks apart. Ankara is only obtainable via your health department and the CDC. Persons who are immunocompromised might also require treatment with vaccinia immune globin as they might not respond to the vaccination.
Is monkeypox a sexually transmitted infection (STI)?
MPXV both is and isn’t an STI. The traditional definition of a sexually transmitted infection is that it is spread primarily through sexual contact. Since MPX is a virus spread from skin-to-skin contact, it can be transmitted without having sex. However, having sex increases the potential risk for infection due to the high likelihood of physical intimacy. MPX can also be spread via fluids such as seminal, vaginal, or anal fluid. The WHO makes the recommendation to use condoms consistently during any sexual activity for 12 weeks after recovering from MPX. MPXV has been found in semen and vaginal fluids, but the role of sex or intercourse in the spread of the virus is not currently known.
Most importantly, if you are someone in a social group that is seeing increased MPX infection and activity, check in with sexual partners about exposure or symptoms. If you have an exposure or symptoms, consider holding off on sex for the time being. This will help stop the spread of MPXV, and help you avoid being infected too. In general, it just makes sense to ask your sexual partner(s) if they have been exposed to MPX or any recent infections. The same goes for asking about other infectious symptoms—whether that is MPX, COVID-19, or a common cold. It should be normalized to ask our sexual partners about exposure or risk to all kinds of infections, as, ideally, we want ourselves and our partners to be safe and healthy.
Want to speak 1-on-1 with a clinician about monkeypox? Book a Virtual Primary Care visit this week. We can offer: education, counseling, information on symptoms and safety, and help finding a vaccination or treatment site if a person meets the criteria. We cannot offer: MPX vaccination, lab tests, MPX treatment.