Mpox (monkeypox)

Mpox cases continue to emerge globally, following initial global outbreaks in 2022. The World Health Organization (WHO) declared the outbreak a public health emergency of international concern, and while this has now ended, we continue to see cases and some countries are seeing resurgences. There is still a need to remain vigilant.

Globally, gay, bisexual, and other men who have sex with men, and their sexual partners are disproportionately at risk of 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 since 2022 cases have begun to emerge globally. The wide spread of the virus in the current outbreaks indicate 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. However, mpox can be acquired by anyone as it is transmitted through close contact between humans.

Signs and symptoms of mpox

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. 

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 the recent outbreaks. 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 the current global 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 been spreading during sexual contact. Some people are also developing lesions without the flu-like symptoms first. 

How is mpox spread?

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. 

In this current global outbreak, sustained skin-to-skin contact, like that during sexual activity, is the most 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. 

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 appears to be rare in the current outbreaks. 

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, fatigue and other flu-like symptoms) may be signs of many common conditions, some of which are also infectious and require medical attention. If you have flu-like symptoms, do not panic, stay home and isolate. You can call a sexual health clinic or speak to your doctor.

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

While gay, bisexual and other men who have sex with men (GBM) are not the only people at risk of mpox, in the current global outbreak, mpox 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, 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! 

Mpox and 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 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.

Vaccination

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 can be used to prevent mpox before you have been exposed or after you have been exposed to prevent more severe symptoms from developing.