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Monkeypox (mpox)

Mpox (monkeypox) is in the community in Aotearoa.

Mpox cases have been found in countries that have never seen cases before and the World Health Organisation (WHO) has declared the outbreak a public health emergency of international concern.

We know that globally, gay, bisexual, and other men who have sex with men, and their sexual partners are currently disproportionately affected by mpox.

 

What is mpox?

Mpox is an orthopoxvirus, related to smallpox, but less severe. It causes a viral disease with prominent symptoms of lesions/spots/blisters/rash on the body.

Mpox is normally found in Central and Western Africa, but cases are now occurring globally. The monkepox virus was first found in monkeys, hence the disease was named ‘monkeypox’ but this is not totally accurate – the virus can be spread by animals other than monkeys and in the recent outbreak, was spreading person-to-person. Person-to-person transmission was previously thought to be rare, but the wide spread of the virus in the current outbreak indicates the virus can spread more easily than previously thought.

The cases globally have occurred mostly among gay, bisexual, and other men who have sex with men (GBM). Cases have also been seen with their sexual partners, and intimate contacts. Mpox can be acquired by anyone, but in this outbreak, it is the GBM communities and their partners that are mostly affected.

 

Signs and symptoms of mpox

The time from exposure to mpox to showing symptoms is normally between 6 and 13 days, but symptoms can start as early as three days after exposure and as late as 21 days.

Typically, the first signs of 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. Sometimes these lesions form without any other symptoms – this has been occurring more frequently in this outbreak. The 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.

In this outbreak, the symptoms that people experience are not following the same patterns as previous cases. For many cases, the lesions have developed on the genitals and/or around and in the butt first and have not always spread to the rest of the body. The presence of lesions around the anus and genitals may indicate that mpox has ben spread during sexual contact. Some people are also developing lesions without the flu-like symptoms first.

 

 

How is mpox spread?

Mpox is transmitted through skin-to-skin contact, contact with skin lesions, and through the transfer of bodily fluids such as saliva.

Skin to skin contact is the main way that mpox is transmitted. In this outbreak, sustained skin-to-skin contact, like that during sexual activity, is a common way that mpox has spread. That being said, mpox has not been classified as a sexually transmitted infection – as it is not exclusively transmitted through sexual contact.

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.

Contaminated 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 been some rare cases where mpox has been transmitted through respiratory droplets. This is rare in this outbreak.

What should I do if I think I have mpox?

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, then you should stay home and contact your local health provider or sexual health clinic for an assessment.

This also applies if you are symptomatic and may have acquired mpox through a sexual partner(s) who has also had intimate contact with GBM. 

Note: Testing is free at your GP or local sexual health clinic.

 

The most prominent symptom of mpox are the lesions, so be alert to any skin changes or lesions that might develop. Sometimes the spots form in places where they are not seen easily (e.g. in or around the butt and/or on the perineum) – any pain in these areas could indicate an mpox lesion, so also be mindful of this.

It is important to remember that the early symptoms of mpox (fever, swollen lymph nodes, muscle aches, and fatigue) may be signs of many common conditions, some of which are also infectious and require medical attention. If you have symptoms, do not panic, stay home and isolate. You can call Healthline or speak to your doctor.

Why are gay, bisexual, and other men who have sex with men affected?

While gay and bisexual men (GBM) are not the only people at risk of mpox, in the current outbreaks worldwide, monkeypox is disproportionately affecting GBM. 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, some people may not know yet they have mpox, and there have been some cases that are asymptomatic.


GBM communities are often closely connected through sexual networks corresponding to a relatively small population. We also know that cases of mpox among GBM were successfully identified thanks to vigilance about sexual health. 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 not stigmatising. It can be easy to associate the spread of infections with moral judgements about people’s sexual behaviours or sexualities. Such stigma is counterproductive to the collective need to identify cases and contain spread as it may cause people to avoid appropriate healthcare!

 

Mpox and HIV

People living with HIV are not necessarily at increased risk of acquiring monkeypox or having a more severe course of illness with mpox. Evidence suggests that those who are virally suppressed and on antiretroviral treatment may experience the same course of illness as anyone else. People living with HIV who are not virally suppressed or have a low CD4+ Count are more likely to experience worse symptoms.

People living with HIV should keep in touch with their healthcare provider and check in regularly if they 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 medicine such as Tecovirimat (available in New Zealand) to help treat mpox or other therapies that can help you feel better.

People living with HIV can be vaccinated. We recommend all people living with HIV get vaccinated when possible to protect themselves against mpox.

 

Vaccination

Globally, there are three vaccines that can be used to prevent mpox. The JYNNEOS (also called Imvamune or Imvanex) vaccine has been used internationally and shows good safety and efficacy. Mpox vaccines can be used to prevent mpox before you have been exposed or after you have been exposed to prevent mpox from developing.

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