Patient education: Mpox (monkeypox) (The Basics)

What is mpox? — 

Mpox, also called monkeypox, is an infection that causes fever and a painful rash. It was originally discovered in monkeys, which is where the word "monkeypox" came from. In late 2022, the name was officially changed to "mpox."

For many years, mpox was uncommon. But starting in 2022, there has been an increase in new cases. These include countries where people typically do not get mpox, including the US.

What are the symptoms of mpox? — 

Symptoms usually start between 5 and 13 days after a person is infected with the virus. Some people have a few days of feeling sick, similar to the flu. Symptoms might include fever, headache, feeling very tired and achy, and swollen lymph nodes. Then, a few days after these start, a rash appears:

●The rash can look like pimples or blisters (figure 1). It starts as a few small spots, then more appear. Some people first notice the rash in their genital or anal area.

●The rash can also affect the face, inside of the mouth, hands, feet, and other parts of the body.

●The bumps swell with fluid, then pop. Then, they dry up and form scabs, which eventually fall off.

●The rash can be painful, although it might become itchy when scabs start to form.

The rash is sometimes the first or only symptom, and people might not know they are sick until the rash appears. It usually lasts for about 2 to 3 weeks.

Sometimes, people with mpox also get other symptoms, such as:

●Anal symptoms, like pain, swelling, and bleeding

●Sore throat – This can make it hard to swallow or eat.

●Eye symptoms, like swelling, irritation, pain, or trouble seeing clearly

How does mpox spread? — 

In the past, the most common way was from an infected animal to a person. This could happen from touching the animal's body fluids or through a bite or scratch.

The infection can also spread from person to person. This can happen through:

●Touching an infected person's rash, scabs, or body fluids – This seems to be the main way the infection spread when cases increased in 2022. This often happens through sexual activity. Experts are studying whether the infection can also spread through semen or vaginal fluids.

●Touching something that has touched an infected person – For example, if fluid from a person's rash gets on clothing, bedding, or sex toys, it is possible for the infection to spread to others who touch these items. This is more likely if the items come in contact with broken skin or a person's genitals, anus, mouth, or eyes.

●Through tiny droplets from the lungs – The infection might spread in this way if people are face to face, like kissing or cuddling, for a long time.

It is also possible for a pregnant person to pass the infection to their baby.

A person is most likely to spread mpox while they have the rash. Experts do not yet know if a person is contagious before the rash appears.

You are not likely to get mpox just by being near someone unless you have direct contact with their skin, or are face to face for a long time.

Who is at risk for mpox? — 

Anyone can get mpox if they have close contact with someone who is infected. When the number of cases started to increase in 2022, many of the people who were infected were men who have sex with men. But it's important to know anyone can get the infection, no matter their gender identity, sexual orientation, or sex practices. Thinking of mpox as something that only affects certain people or groups is inaccurate and harmful.

What should I do if I have symptoms? — 

Call your doctor or nurse. They will ask you questions and schedule an exam. Avoid close contact or sex with others until you have been seen by a doctor or nurse.

Is there a test for mpox? — 

Yes. If your doctor or nurse thinks you might have mpox, they will use a swab to take a sample of your rash. They will send it to a special lab for testing. They might also do blood tests, too.

What should I do if I think I was exposed? — 

If you had close contact with someone who had mpox, tell your doctor or nurse, even if you don't have any symptoms. They can tell you what to do next. This might include getting a vaccine.

If you were exposed to mpox, you will need to monitor yourself for symptoms for 21 days. Then, call your doctor or nurse if you notice any symptoms such as fever, swollen lymph nodes, or any rash or sores.

Who should get the mpox vaccine? — 

In addition to monitoring, experts recommend vaccination for people who know they were exposed to the virus, or have likely been exposed to it. This is called "post-exposure prophylaxis." To work, the vaccine needs to be given before any symptoms start.

You might choose this if you had close contact with someone who had mpox in the last 2 weeks. This could be through:

●Touching the person's rash, scabs, or body fluids

●Touching something that touched the person's rash, scabs, or body fluids (like clothing, bedding, or sex toys)

●Kissing or cuddling

●Oral, anal, or vaginal sex

For health care workers, it's also possible to be exposed in other ways. This could happen through:

●Saliva from a patient with mpox getting into your eyes or mouth

●An accidental needlestick

Experts also recommend vaccination before exposure for people who might be at higher risk. This is called "pre-exposure prophylaxis." You might choose this if any of the following are true (or if you expect them to happen):

●You are a man who has sex with other men, a transgender person, or a nonbinary person, and have done either of these in the last 6 months:

•Been diagnosed with a sexually transmitted infection such as HIV, chlamydia, gonorrhea, or syphilis

•Had more than 1 sex partner

●You have done either of these in the last 6 months, or expect to in the future:

•Had sex at a sex club or bathhouse

•Had sex at an event or place where there have been known cases of mpox

●You have sex partners with any of the risks or behaviors listed above.

●You will be traveling to a country where mpox is spreading, and expect to have sex with a new partner, at a sex club, bathhouse, or festival, or in exchange for money.

●You work in a place where you could be exposed to mpox (for example, in a lab that studies this type of virus).

Vaccination is especially important if you have HIV or other conditions that can weaken your immune system.

Your doctor, nurse, or local public health office can talk to you about the vaccine and your options. Even if you get the vaccine, it's still important to avoid close contact with someone who has mpox.

How is mpox treated? — 

Most people will not get seriously ill, and can stay home while they get better. This usually takes a few weeks.

In some cases, doctors might recommend treatment with "antiviral" medicines.

How can I avoid spreading mpox to others? — 

If you have mpox, there are things you can do to lower the risk of spreading the infection to other people.

The best way is to self-isolate:

●This means staying away from other people as much as possible, even the people you live with.

●Continue to self-isolate until your rash has fully healed. This means the scabs have fallen off and new skin has formed.

To protect others, you should also:

●Wash any clothing, bedding, or other items that have touched your rash. Do not shake out clothing or bedding around other people. If someone else needs to touch these items, or help care for you, they should wear gloves.

●Wash your hands often. Others in your home should also wash their hands often.

●Be extra careful if you do need to be around other people. Cover any parts of your skin that have a rash, and wear a face mask.

How can I avoid being exposed to mpox? — 

The best way to prevent mpox is to avoid close contact with anyone who might have it.

To lower your risk of being exposed:

●If a family member, friend, or partner has mpox, they should self-isolate until their rash has completely healed.

●Avoid close contact with anyone who has symptoms of mpox. If a partner has mpox, avoid sex until their rash is completely healed. This includes anal, oral, or vaginal sex. Virtual or phone sex are safe ways to be intimate without physical contact.

●Using condoms any time you have sex might help. But condoms probably cannot completely prevent the spread of mpox. This is because it can spread in a few different ways, as discussed above.

Where can I go to learn more? — 

You can find more information at the US Centers for Disease Control and Prevention ("CDC") website: www.cdc.gov/poxvirus/mpox.