Patient education: Mpox (monkeypox) (The Basics)

What is mpox? — Mpox, also known as monkeypox, is an infection that causes fever and a painful rash. It was originally discovered in monkeys, which is where the term "monkeypox" came from. In late 2022, the name of the disease was officially changed to "mpox."

For many years, mpox was uncommon. But in 2022, there was an outbreak of new cases. These happened in countries where people typically do not get mpox, including the United States.

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 symptoms start, a rash appears.

●The mpox rash can look like pimples or blisters. It starts as a few small spots, then more appear (figure 1). 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.

For some people, the rash is the first or only symptom they have, and they do not know they are sick until it appears. The rash usually lasts for about 2 to 3 weeks.

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

●Anal symptoms – These can include pain, swelling, and bleeding.

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

●Eye symptoms – These can include swelling, irritation, pain, or trouble seeing clearly.

How does mpox spread? — In the past, the most common way for mpox to spread 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 is spreading during this outbreak. In many cases, this has happened 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 can spread in this way if people are face-to-face, for example 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.

The virus that causes mpox is not as contagious as the virus that causes coronavirus disease 2019 (COVID-19). You are not likely to get it 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. During the 2022 outbreak, many of the people who were infected were men who have sex with men. But it's important to know that 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? — If you have any symptoms of mpox, call your doctor or nurse. They will ask you questions and schedule an exam. If possible, 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 that 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. In some cases, they might do blood tests, too.

What should I do if I think I was exposed? — If you had close contact with someone who had mpox, you should 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. You should 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 some cases after a possible exposure, experts recommend vaccination in addition to monitoring. This might help prevent infection, even in people who were already exposed.

Experts recommend vaccination for people who know that 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:

•Kissing or cuddling

•Oral, anal, or vaginal sex

•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)

●You are a man who has sex with other men, a transgender person, or a nonbinary person, and have done any of the following in the last 2 weeks:

•Had sex with multiple partners or in a group

•Had sex at a sex club or bathhouse

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

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:

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

•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.

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 with mpox will not get seriously ill, and will be able to 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 to avoid spreading the infection to others 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 can 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 healed completely.

●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/monkeypox.