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What is monkeypox?

Monkeypox is an illness caused by a virus closely related to the smallpox virus. Despite the name, these viruses are not related to the chickenpox virus, which is a herpes virus.think of monkeypox and smallpox as their own unique type of virus.

Historically, monkeypox has mostly infected animals in Africa, with an occasional spread to a human. However, this year’s epidemic is a new development. The virus has escaped from its usual animal host and is now spreading from person to person. In particular, it has entered the sexual networks of men who have sex with men, and is increasing among that group, although there are also a smaller number of cases occurring in other people.

What are the symptoms of monkeypox infection?
The virus causes blisters or pustules (“poxes”), which can be very painful. These can appear anywhere on the body. In the current epidemic, they also are commonly found in the “underpants zone,” namely the genital and anal areas. They can also cause swelling and pain inside the anus. People infected with monkeypox may also have fever, muscle aches, headache, cough, swollen lymph nodes, loss of appetite, and other symptoms. People with monkeypox are generally ill for 3–4 weeks and must quarantine to prevent further transmission.

How is monkeypox spread?
Most commonly this virus is spread by skin-to-skin contact, such as during sex, especially via contact with the fluid from one of the pox lesions. Monkeypox may also be transmitted by respiratory secretions and by body fluids such as semen. Close intimate contact seems to be the most common way it is transmitted, as opposed to simply being in the same room as someone. However, because of the risk of transmission, a person with monkeypox is asked to isolate from other people until they have fully recovered.

Is monkeypox a sexually-transmitted infection (STI)?
It depends how you define STI. According to authorities, monkeypox is not an STI because it does not require sex for transmission, just skin contact with the virus. However, the same could be said of herpes, which is often thought of as an STI, but is easily transmitted by non-sexual skin contact. There are many other STIs that can be transmitted non-sexually, for example by transfusion, needle sharing, perinatally, etc.

Also, just “being gay” does not put a person at risk of monkeypox; rather, it’s who you have intimate contact with. This is important as gay males, who are not sexually active at all, express a (mistaken) fear that they are at risk of getting monkeypox. It is not how one identifies; it is what one does intimately, and with whom that exposes a person to this virus.

How does a person get tested for monkeypox?
A health care provider swabs the fluid from a pox lesion and sends the swab to a lab for testing. This test is now available via large commercial labs in the U.S. There is no self-testing yet, and there is no blood test. A person must have at least one pox lesion in order to be tested. In that case, they should go to a health care provider—either their primary care provider, a walk-in clinic, or sexual health clinic, etc. Clinics that typically see men who have sex with men are more likely to be up to date on how to obtain and send a specimen for testing.

How can monkeypox be prevented?
The most surefire way would be for a man to not have sexual contact with new male partners for the time being, since the virus is circulating primarily among men who have sex with men, and by intimate (often sexual) contact. It’s helpful to know who you are intimate with, whether they have a rash or other symptoms, or have been ill recently. Sex clubs, sex parties, and other similar settings pose a high risk of infection if a participant has this virus.

There is also a vaccine, JYNNEOS, that is effective at preventing monkeypox (and smallpox). The vaccine is given as a shot under the skin, usually in the upper arm, with a second dose a month later. People tend to have minimal aftereffects from the vaccine. Protection begins a few weeks after the first dose. Although it is a live (but "crippled) vaccine, JYNNEOS appears safe for people living with HIV, at least if their CD4 count is over 200. 

JYNNEOS can also be given for post-exposure prophylaxis. If a person has had close/intimate contact with someone who proves to have monkeypox, the person can get a dose of vaccine. If given soon enough it may prevent the infection completely, or (especially if given more than a few days after exposure) it still may make the infection less severe.

The supply of JYNNEOS is limited, although much more will be available over the next few months. It is being distributed by the CDC and local health departments, and from there to clinics where it is given to patients. Currently in the United States the supply is allocated to cities and counties based on the number of cases there.

“I am ‘older’ and I had the smallpox vaccine when I was a child, which younger folks have not had. Will this vaccine protect me from monkeypox?”  We know that the immunity from smallpox vaccine fades with age. The smallpox vaccine that some older folks had decades ago is unlikely to prevent monkeypox now. However, it may help reduce the severity of the disease if the person catches monkeypox.

How is monkeypox treated?
Most people with monkeypox do not need antiviral treatment; their system clears the virus on its own. The most common treatments a person might need are for control of symptoms such as pain and fever. There is an experimental antiviral (tecovirimat, or TPOXX) that can be obtained for people with severe symptoms. This is not available at regular pharmacies and would have to be accessed through the local health department, infectious disease clinic, or other clinic that has been authorized. HIV antivirals do not treat monkeypox, nor do antivirals designed for other infections such as herpes, flu, COVID-19, etc.

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