22nd June, 20229 min read

Monkeypox: Your guide to symptoms, how it spreads and treatments

Medical reviewer:
Dr Ann Nainan
Dr Ann Nainan
Dr Adiele Hoffman
Dr Adiele Hoffman
Author:
Jo Waters
Jo Waters
Last reviewed: 21/06/2022
Medically reviewed

All of Healthily's articles undergo medical safety checks to verify that the information is medically safe. View more details in our safety page, or read our editorial policy.

Monkeypox is a rare disease caused by a virus that makes your skin break out with spots or blisters filled with pus. It was previously only found in humans in the tropical rainforests of the Democratic Republic of Congo and Nigeria and was occasionally brought to other countries by travellers.

But in 2022, monkeypox outbreaks began to be reported in regions of the world where the virus isn’t regularly found, including Europe, United States of America and Australia.

If you’re worried about the outbreaks closer to home, read on to find out all you need to know about spotting the symptoms, stopping the spread and staying safe.

What is monkeypox?

Monkeypox is a disease caused by the monkeypox virus. It was first discovered in 1958 when a pox-like disease was spotted in monkeys kept for research purposes. The first human cases were reported in the Democratic Republic of Congo in 1970. It is related to smallpox, a virus that was wiped out worldwide in 1980 – drugs and vaccines developed to protect against smallpox may be used to prevent and treat monkeypox.

Key facts

  • the virus doesn’t spread easily amongst people
  • in most cases people with monkeypox get better by themselves
  • it usually takes around 2 to 3 weeks to recover
  • incubation period (the time it takes to develop symptoms after you’ve been in contact with an infected person) is usually between 6 and 13 days, but it can range from 5 to 21 days

In a small number of cases monkeypox is more serious, and 3 to 6% of people die from it. Groups who are more at risk for severe illness include:

  • children under 8 years old
  • pregnant people
  • those with a weakened immune system
  • people with eczema

What are the symptoms of monkeypox?

The illness has 2 phases.

The invasion phase

This lasts up to 5 days and symptoms include:

  • fever
  • intense headache
  • swelling of lymph nodes – part of your body’s immune system, they look a bit like baked beans and you might notice the swelling in clusters of them in your neck, armpit, chest, tummy and groin
  • back pain
  • muscle aches
  • exhaustion
  • chills/shivering

Rash and blisters phase

  • this begins between 1 and 3 days after the fever starts
  • the rash usually begins on your face and spreads to other parts of your body, including the soles of your feet, palms of your hands, inside your mouth and genitals. It can also affect your eyes, making them look red
  • the number of spots varies – some people have just a few, others may have thousands
  • the rash changes from spots with a flat base, to slightly raised ones which feel firm
  • then blisters filled with clear fluid form. The fluid eventually turns yellow
  • the blister crusts over, dries up, then the scabs fall off

Complications of monkeypox

Most people get better without treatment within a few weeks. But in some cases there can be complications, including secondary infections such as serious chest infections affecting your lungs, sepsis (a life-threatening reaction to an infection), and encephalitis (inflammation of the brain).

How do you catch monkeypox?

The virus doesn’t spread easily, but you’re at higher risk if you’ve visited a country that has an outbreak. Here are some of the ways you might catch it:

Contact with people

  • direct contact with another person who has monkeypox sores, scabs or through body fluids
  • prolonged face-to-face contact with droplets from sneezing or coughing by an infected person – scientists don’t know exactly how long someone would have to be in close contact yet and it’s likely to vary between individuals
  • intimate contact with an infected person, including sex, kissing, cuddling or touching parts of the body infected by sores

Monkey

Contact with animals

Monkeypox can be spread by contact with infected animals. It’s not known which animal is the natural carrier of monkeypox but it has been found in several different species in parts of Africa, including rats, squirrels, mice and monkeys. It’s thought this could be via:

  • a bite or scratch from an infected animal
  • by handling or eating bushmeat infected with the virus – this type of meat is usually raw or minimally processed and comes from wild animals such as bats, monkeys and rodents, in certain regions of Africa
  • using products such as creams, lotions or powders, which are derived from such animals

Contact with materials recently contaminated with the virus

  • bedding, towels or clothes used by someone with the monkeypox rash
  • objects and surfaces recently touched by someone with the monkeypox virus, for example if they have a sore on their hand

What to do if you think you have monkeypox

If you have a rash you think might be monkeypox and any other symptoms mentioned above, and you believe you may be infected, follow the advice below.

Even if you haven’t got a rash yet but you have other symptoms such as fever and have been in close contact with someone with monkeypox, you should take these measures:

  • contact your doctor for advice – but don’t go in person unless you’re told to as you may spread the virus
  • avoid face-to-face and skin-to-skin contact with anyone you live with and wear a mask
  • clean surfaces and objects you have touched
  • don’t share towels
  • isolate at home

Monkey pox test

How is monkeypox diagnosed?

If you’re asked to go to a clinic or hospital in person, your doctor or nurse will be wearing personal protective equipment (PPE) to stop the spread of infection.

If your doctor suspects you have monkeypox they will take a sample from one of your spots or blisters, or from a dry scraping of your scab. This is then tested for the monkeypox virus with a PCR test.

Are there high risk groups for monkeypox?

People at higher risk of catching monkeypox

You should be particularly alert to new blisters, sores or ulcers, if:

  • you’ve had a new sexual partner recently
  • you’re a gay or bisexual man, or a man who has sex with men, and you’ve had new partners recently. That’s because most of the cases in Europe and the US identified in 2022 have been diagnosed through sexual health clinics in people from the same sexual networks in these groups

Transgender people and gender diverse people may also be more vulnerable if it’s spreading within their sexual network.

But that’s not to say that you’re only at risk if you’re in these groups – anyone can catch monkeypox. It’s also important to note that monkeypox is not thought to be sexually transmitted, but it’s the close physical contact that comes with sex that can lead to the spread – which is why you should look out for symptoms if you’ve had sex with someone new, regardless of your sexuality.

What are the treatments for monkeypox?

Eat well and drink fluids

Milder cases of monkeypox get better on their own without any treatment (you might hear doctors calling it self-limiting). The official advice is simple – keep eating and drink plenty of fluids.

Antiviral drugs

There’s no specific drug to treat monkeypox, but there are a number of drugs which were developed to treat other conditions and viral infections that may help reduce how severe the disease is. These don’t have a specific licence for monkeypox yet in the US or the UK, but in the US they’ve been approved by regulators to treat monkeypox during an outbreak.

These drugs include:

  • Tecovirimat (TPOXX) – developed to treat smallpox. Research is being carried out on how well it works against monkeypox, but it has worked against viruses from the same family. In animal studies Tecovirimat reduced the severity of the disease, but it has only been used in a few human cases so far
  • Cidofovir – developed to treat cytomegalovirus (CMV), a common virus that’s part of the herpes family
  • Vaccinia immune globulin (VIG) – developed to treat complications of the original smallpox vaccination

Vaccine

Smallpox vaccines for monkeypox prevention

The smallpox virus is very similar to the monkeypox virus. Vaccines made for smallpox are actually around 85% effective against catching monkeypox if you’re exposed to the virus.

Here’s what we know about smallpox vaccines so far:

  • experts have said that vaccination may help prevent someone getting monkeypox after they’ve been exposed to it, or make the illness less severe
  • smallpox vaccines being used against monkeypox include JYNNEOS (also known as Imavire or Imvanex) which has been licensed in the US
  • another smallpox vaccine, ACAM2000, is also being investigated in the US

Ring vaccination

Although neither of the vaccines mentioned above are currently available to the general public, some countries including the US, Canada and UK, have started to give those who have been exposed to monkeypox the smallpox vaccination. It’s what’s known as a ‘ring vaccination’ approach, where the smallpox vaccine is given to people who have been exposed to monkeypox. It’s hoped it might help stop the spread of the virus.

The UK Health Security Agency has recommended that some gay and bisexual men at higher risk of exposure to monkeypox should be offered a smallpox vaccine, shown to be effective against monkeypox. NHS England is due to set out details of how eligible people can get vaccinated.

What are the chances of monkeypox becoming a pandemic?

Monkeypox, unlike COVID-19, is not a new virus – it’s been around for decades. There are 2 big differences between monkeypox and COVID-19:

  • monkeypox doesn’t spread as easily as COVID-19 which is more infectious
  • we already have vaccines developed for smallpox which are effective against monkeypox

The risk is still low

The World Health Organisation (WHO) says monkeypox is not typically considered to be very contagious. This is because it requires close physical contact with someone who is infectious in order for the virus to spread between people. Ultimately, the WHO says the risk to the general public is low.

Dr Adiele Hoffman says:

“We don't know exactly why monkeypox has suddenly appeared as outbreaks in countries around the world where this hasn't happened before. Scientists haven't found any evidence that the virus itself has changed. One theory is that a reduced immunity to smallpox has a role to play. After smallpox was wiped out, we no longer needed to vaccinate children against it. So this may have left us more vulnerable to monkeypox, allowing it to spread as we are seeing.”

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