Get the Facts: Monkeypox

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image source: https://www.cdc.gov/poxvirus/monkeypox/response/2022/index.html

Cases of monkeypox virus have recently been identified in Europe and the US. Some, but not all, cases have been identified among gay, bisexual or men who have sex with men. Anyone can get infected with Monkeypox. Updated case totals can be found on the CDC website.

What You Should Know

  • Monkeypox is spread through close contact with body fluids, sores, shared bedding or clothing, or respiratory droplets (kissing, coughing, sneezing).
  • Common symptoms:  Rash or unusual sores on face, body, and genitals, fever, chills, head or muscle aches, or swelling of lymph nodes.
  • Avoid close contact (touching sores, kissing, sex) with anyone who has a rash or symptoms of Monkeypox.
  • Clinicians: Please refer to our Chicago HAN page for additional information including specimen collection and infection prevention guidance

If you or a recent partner (from the last 21 days) have been exposed or have symptoms, you should see a healthcare provider (remind them monkeypox is circulating), cover rash/sores, wear a mask, and avoid close contact with others. If you do not feel well or have an unusual rash or sores, take a break from sex and going out to bars, gyms, clubs, and other events.


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Monkeypox – Questions and Answers

Monkeypox is a disease caused by the monkeypox virus. It is a viral zoonotic disease, meaning that it can spread from animals to humans. It can also spread between people.

Monkeypox is commonly found in central and west Africa where there are tropical rainforests and where animals that may carry the virus typically live. People with monkeypox are occasionally identified in other countries outside of central and west Africa, following travel to regions where monkeypox is endemic.

Several countries where monkeypox is not common have reported cases since May 2022. Globally, 36 countries have reported 2,037 confirmed cases and the United States has reported 84 confirmed cases in 18 states and the District of Columbia as of June 15, 2022. Most of the infected individuals have reported only mild symptoms, and none have died. Additional cases are being investigated. Updated case counts by U.S. state can be found here: https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html

Except for cases sporadically reported in travelers from endemic countries, cases in non-endemic areas (with no link to travel) are uncommon.

In this outbreak, skin-to-skin contact with infectious skin lesions during intimate sexual activity (e.g., oral, anal, and vaginal sex or touching the genitals or anus) may be the likely mode of transmission. Studies are underway in affected countries to determine the source of infection of each identified case, and actions are being taken to provide medical care and limit further spread.

Symptoms of monkeypox typically include a rash, fever, chills, swollen lymph nodes, intense headache, muscle aches, back pain, and low energy. The rash usually begins within one to three days after the appearance of fever, often beginning on the face then spreading to other parts of the body. Lesions can be flat or slightly raised, filled with clear or yellowish fluid, and can then crust, dry up and fall off. The number of lesions on one person can range from a few to several thousand. The rash tends to be concentrated on the face, palms of the hands and soles of the feet. They can also be found on the mouth, genitals, and eyes.

Symptoms typically last between 2 to 4 weeks and go away on their own without treatment. If you think you have symptoms that could be monkeypox, seek advice from your health care provider. Let them know if you have had close contact with someone who has suspected or confirmed monkeypox.

Monkeypox is spread from person to person through close physical contact, often skin-to-skin contact including:

  • Direct contact with monkeypox rash, sores, or scabs from a person with monkeypox. We believe this is currently the most common way that monkeypox is spreading in the U.S.
  • Contact with objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox.
  • Contact with respiratory secretions, through kissing and other face-to-face contact.

The risk of monkeypox is not limited to people who are sexually active or self-identify as gay, bisexual, or other men who have sex with men. Anyone who has close physical contact with someone who is infectious is at risk. Anyone who has symptoms that could be monkeypox should seek advice from a healthcare provider immediately. This includes people who have connections to communities where cases have been reported.

Several of the cases that have been reported from non-endemic countries have been identified in self-identified gay, bisexual, or other men who have sex with men. These cases were identified at sexual health clinics. The reason we are currently hearing more reports of cases of monkeypox in communities of men who have sex with men may be because of positive health seeking behaviors in this demographic. Monkeypox rashes can resemble some sexually transmitted diseases, including herpes and syphilis, which may explain why these cases are being picked up at sexual health clinics. It is possible that we may identify cases in the broader community.

If you or any recent partners have unusual sores or a rash, go see a healthcare provider. Remind your provider that monekypox is circulating. If you need help finding a medical provider because you are worried about syphilis, herpes, or monkeypox, please call the HIV/STI Resource Hub at 1-844-482-4040.

monkeypox rash
Example Monkeypox Rash
Example of Monkeypox Rash
Example of a Monkeypox Rash

Photo Credit: NHS England High Consequence Infectious Diseases Network

People with monkeypox are infectious while they have symptoms (normally for between two and four weeks). You can catch monkeypox through close physical contact (often skin-to-skin contact) with someone who has symptoms. The rash, bodily fluids (such as pus or blood from skin lesions) and scabs are particularly infectious. Clothing, bedding, towels, or objects like eating utensils/dishes that have been contaminated with the virus from contact with an infected person can also infect others.

Ulcers, lesions or sores in the mouth can also be infectious, meaning the virus can spread through saliva. People who closely interact with someone who is infectious, including health workers, household members and sexual partners are therefore at greater risk for infection.

The virus can also spread from someone who is pregnant to the fetus from the placenta, or from an infected parent to child during or after birth through skin-to-skin contact.

It is not clear whether people who do not have symptoms can spread the disease.

Anyone who has close physical contact with someone who has symptoms of monkeypox.

Even though people who have been vaccinated against smallpox will have some protection against monkeypox, they also need to take precautions to protect themselves and others.

Newborns, children and people with underlying immune deficiencies may be at risk of more serious symptoms and death from monkeypox. Health workers are also at higher risk due to longer virus exposure.

You can reduce your risk by limiting contact with people who have suspected or confirmed monkeypox.  

If you need to have physical contact with someone who has monkeypox because you are a health worker or live together, encourage the infected person to self-isolate and cover any skin lesion if they can. When you are physically close to them, they should wear a medical mask, especially if they are coughing or have lesions in their mouth. You should wear one also. Avoid skin-to-skin contact whenever possible and use disposable gloves if you have any direct contact with lesions. Wear a mask when handling any clothes or bedding if the person cannot do it themselves. 

Regularly clean your hands with soap and water or an alcohol-based hand rub, especially after contact with the person who is infected, their clothes, bed sheets, towels and other items or surfaces they have touched or that might have come into contact with their rash or respiratory secretions (e.g., utensils, dishes). Wash the person’s clothes, towels, bedsheets, and eating utensils with warm water and detergent. Clean and disinfect any contaminated surfaces and dispose of contaminated waste (e.g., dressings) appropriately. 

If you or a partner has monkeypox, the best way to protect yourself and others is to not have sex of any kind (oral, anal, vaginal) and not kiss or touch each other’s bodies while you are sick, especially any rash or sores. Do not share things like towels, fetish gear, sex toys, and toothbrushes. 

If you or your partner have (or think you might have) monkeypox and you decide to have sex, consider the following to reduce the chance of spreading the virus: 

  • Have virtual sex with no in-person contact. 
  • Masturbate together at a distance of at least 6 feet, without touching each other and without touching any rash or sores. 
  • Consider covering areas where rash or sores are present, reducing as much skin-to-skin contact as possible. 
  • Avoid kissing. 
  • Remember to wash your hands, fetish gear, sex toys and any fabrics (bedding, towels, clothing) after having sex. 
  • Limit your number of partners to avoid opportunities for monkeypox to spread. 

If you think you have symptoms or have been a close contact of someone with monkeypox, contact your healthcare provider for advice, testing and medical care. Also consider the following:

  • Avoid sex or being intimate with anyone until you have been checked out by a healthcare provider. If you don’t have a provider or health insurance, visit a public health clinic near you.
  • When you see a healthcare provider, remind them that this virus is circulating in the area.
  • Avoid gatherings, especially if they involve close, personal, skin-to-skin contact.

Think about the people you have had close, personal, or sexual contact within the last 21 days, including people you met through dating apps. You might be asked to share this information if you have received a monkeypox diagnosis, to help stop the spread.

Yes, if you have been told by a healthcare provider that you have a monkeypox infection or suspect you may have monkeypox, you should isolate. Persons who do not require hospitalization can isolate at home. Below are a couple of protective measures you can take at home:

  • Do not leave your home except as required for follow-up care.
  • Limit contact with household members who are not ill. If you have extensive sores that can’t be covered or if you are experiencing respiratory symptoms, isolate in a room separate from other family members and pets when possible.
  • If you do need to be in contact with others in the home, both you and your other household members should wear a well-fitting surgical mask.
  • Restrict visitors to those who are essential to being in the home, especially if they have not been previously exposed.
  • Avoid contact with animals, including pets, when possible.
  • Avoid use of contact lenses to prevent inadvertent infection of the eye.
  • Avoid shaving areas of the body with lesions as this can lead to spread of the virus.
  • Household members who are not ill should limit contact with you until your lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed; non-household members should not visit.
  • After ending isolation when all scabs have fallen off, use safe sex, barrier practices (i.e., wearing condoms) for at least 8 weeks.

If you are isolating at home, your isolation can end when all lesions have resolved, all scabs have fallen off, and a fresh layer of intact skin has formed. This process can typically take 2-4 weeks. Due to this, the timing of isolation will vary from person to person. Individuals with monkeypox should contact their healthcare provider to determine if it is appropriate to end isolation. If you do not have a provider or health insurance, visit a public health clinic near you.

Once an individual with monkeypox ends isolation, they should avoid close contact with immunocompromised persons until all scabs have fallen off. Immunocompromised persons include persons with immunologic disorders (e.g., human immunodeficiency virus [HIV] infection or congenital immune deficiency syndrome), chronic diseases (e.g., diabetes, cancer, emphysema, or cardiac failure), or persons on immunosuppressive therapy (e.g., radiation, cytotoxic chemotherapy, anti-rejection medication, or steroids).

Monkeypox can spread from one person to another through close physical contact, including sexual contact. It is currently not known whether monkeypox can be spread through sexual transmission routes (e.g., through semen or vaginal fluids), but direct skin-to-skin contact with lesions during sexual activities can spread the virus.

Monkeypox rashes are sometimes found on genitals and in the mouth, which is likely to contribute to transmission during sexual contact. Mouth-to-skin contact could also cause transmission where skin or mouth lesions are present.

Monkeypox rashes can resemble some sexually transmitted diseases, including herpes and syphilis.

Ask you sex partners about symptoms. See if they have had any unusual rashes and sores in the last 3 weeks.

The risk of becoming infected with monkeypox is not limited to people who are sexually active or gay, bisexual, or other men who have sex with men. Anyone who has close physical contact with someone who is infectious is at risk. Anyone who has symptoms that could be monkeypox should seek advice from a health worker immediately.

Monkeypox is a potentially serious viral illness; however, the United States has tools at hand to respond to its emergence. Chicago Department of Public Health (CDPH) continues to support clinical partners with testing to identify infected individuals, isolate anyone found to be infected with the virus, trace infected individuals' close contact with others, and monitor for symptom onset during the incubation period. In collaboration with federal partners, CDPH coordinates post exposure prophylaxis of exposed contacts as well as treatment with antiviral medication for those with more severe illness.



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