Mpox (Monkeypox)

Symptoms

Typically, the first signs of an mpox infection are swollen lymph nodes, fever, muscle aches, and fatigue (flu-like symptoms). These are typically followed a few days later by lesions (sometimes referred to as spots, blisters, skin changes, or rash) on the body, but these may also form without any other symptoms.

Lesions are spots on the skin that fill with fluid, crust over, and eventually flake off. The lesions can be quite painful or itchy and can take a few weeks to heal.

The time from exposure to the mpox virus to showing symptoms is normally between 7 and 14 days, but symptoms can start as early as 5 days after exposure and as late as 21 days.

How can you get it?

Mpox is usually transmitted through skin-to-skin contact, though it can also be transmitted through contact with skin lesions or rashes, and through the transfer of bodily fluids such as saliva.
People who have close contact with people diagnosed with mpox (e.g., household members and healthcare workers) can also acquire mpox and should take precautions to avoid infection if they are in contact with someone with mpox.

Objects such as sheets, towels, clothing, or sex toys can also carry the virus, and so should be cleaned as required and not shared with people who have mpox. There have also been some rare cases where mpox has been transmitted through respiratory droplets.

How do you know if you have it?

Mpox may be hard to identify as it shares many symptoms with other common illnesses such as the flu, and can also present similar to syphilis. If you have symptoms consistent with mpox and have recently had intimate contact with gay, bisexual, and/or other men who have sex with men, the best way to know for sure is to get tested.

Find out more about free mpox testing here.

Isolation requirements

If you have mpox, you will only need to isolate at home for a minimum of 7 days from when your lesions first appeared. But from day 8 onwards, a Medical Officer of Health will assess whether you can leave isolation.

Some precautions may still be required until all the lesions are completely crusted over and scabs have fallen off e.g. covering lesions, mask wearing, and informing healthcare providers of your mpox diagnosis before arriving.

They will make their decision based on things like your symptoms (e.g. have you developed any new lesions in the past 48 hours) as well as assessing your occupation/workplace environment (e.g. will you be in contact with people at high risk of serious disease from mpox).

You can find more info about requirements and best practices for cases and close contacts here.

Prevention

The JYNNEOS vaccine has been used internationally to prevent the transmission of mpox and risk of severe disease, and it shows good safety and efficacy. Mpox vaccines are primarily used to prevent mpox before you have been exposed, but can also be used after you have been exposed to prevent more severe symptoms from developing.

Find out more about mpox vaccines and local availability here.

You can also read more about what you can do to reduce your chances of acquiring mpox here.

Partner notification

If you acquire mpox, some people will need to know so they can protect themselves or support you, but you won’t have to tell anyone who doesn’t need to know.

Treatment

Mpox will go away on its own. While there is no official treatment for mpox, there are medications you can be prescribed, such as tecovirimat / Tpoxx to manage any discomfort you’re feeling, as mpox can be quite painful.

I’m living with HIV

People living with HIV are not necessarily at increased risk of acquiring mpox or having a more severe course of illness with mpox. Evidence suggests that those who are virally suppressed and on effective antiretroviral treatment may experience the same course of illness as a person living without HIV. People living with HIV who are not virally suppressed or have a low CD4+ count are more likely to experience worse symptoms.

If you're living with HIV, regardless of immune function, keep in touch with your healthcare provider and check in regularly if you have mpox. If you feel particularly unwell and/or are experiencing severe symptoms and/or pain (particularly in the butt), it is important you seek medical attention as soon as possible. You may be able to access treatment to help treat mpox or other therapies that can help to make you feel better.

We recommend all people living with HIV get vaccinated to protect themselves against mpox.

Who is most affected?

While gay, bi, and other men who have sex with men (GBM) are not the only people at risk of mpox, in the current global outbreak, this is who mpox is disproportionately affecting. Sex can make transmission easier because of skin-to-skin contact and the transfer of bodily fluids such as saliva or semen during sex. Skin lesions may not be obvious or may be in places where they are not visible initially, and therefore some people may not know they have mpox and may be infectious. There have also been some cases that are asymptomatic.

GBM are often closely connected through close sexual networks in a relatively small population. We also know that cases of mpox among GBM were successfully identified thanks to vigilance about sexual health – this is something our communities are great at. Continuing to monitor symptoms and seeking medical advice when symptoms develop will help to protect our communities.

It is important that our conversations about mpox and GBM are never stigmatising. It can be easy to associate the spread of infections with moral judgements about people’s sexual behaviours or sexualities. There is no shame in acquiring mpox, and avoiding transmitting mpox is a good thing. Stigma is counterproductive to the collective need to identify cases and contain spread as it could cause people to avoid appropriate healthcare!