How does monkeypox spread? 9 common questions and how to protect yourself

According to the Centers for Disease Control and Prevention, there are now over 5,000 confirmed cases of monkeypox (orthopoxvirus) in the United States, and cases are growing globally. Monkeypox is a part of the same family of viruses as smallpox (variola virus) but is milder than smallpox and unrelated to chickenpox. Monkeypox also isn't new: the first human case was recorded in 1970.

"Although the monkeypox virus is the same virus as the one first isolated years ago, it is now behaving differently," says Sara Bares, MD, Nebraska Medicine infectious diseases physician. "In the past, monkeypox began with flu-like symptoms (e.g., fever and muscle aches) followed by a rash that started on the face and spread downward and outwards. What we're seeing with this outbreak is different. Most cases begin with lesions in the genital or anal area, or a rash in one or more areas of the body with or without previous flu-like symptoms." 

Here we will answer nine common questions based on what we currently know and how to protect yourself.

1. How does monkeypox spread?

A person with monkeypox can spread it to others from the onset of symptoms until the rash has fully healed (scabs have fallen off) and a new layer of skin has formed. The illness usually begins within two to three weeks of exposure. Once infected, the illness typically lasts two to four weeks.

Monkeypox is most commonly spread through close, face-to-face or direct skin-to-skin contact. 

Ways it can be transmitted include:

• Contact with monkeypox rash, scabs or body fluids from an infected person 
• Contact with objects and fabrics (clothing, bedding or towels and other surfaces) that have been frequently used by an infected person and have not been disinfected
• Contact with respiratory secretions, as with prolonged, close face-to-face conversations with an infected person
• Direct contact during sexual intimacy (oral, anal and vaginal) with an infected person, including prolonged contact through hugging, cuddling and kissing
• A pregnant person can spread the virus to their fetus through the placenta
• It is possible to be infected by an animal with monkeypox, and it is possible to pass the infection to an animal but this has not yet been described in the current outbreak

We don't yet know whether or not monkeypox can spread before a person develops symptoms and/or whether or not monkeypox can be transmitted via semen, saliva, and other fluids.

2. Is monkeypox an STI?

There are false rumors online claiming people can only get monkeypox if they have sex with an infected person. On the contrary, monkeypox is a virus that can be transmitted with or without sexual contact. It is not considered a sexually transmitted infection, but it is an infection that can be transmitted by sexual contact. Scientists are currently investigating whether it spreads through semen, anal or vaginal fluids.

3. Does monkeypox only occur in men who have sex with men?

No. While a high percentage (98%) of current monkeypox cases involve men who have sex with men, it is not exclusively transmitted this way. Although the recent outbreak is currently affecting gay or bisexual men disproportionately, it can affect anyone and is not exclusive to this group. 

4. Can monkeypox kill a person?

Monkeypox is not usually a deadly disease, but it can be very painful and present with severe symptoms that may require hospitalization. It can also significantly affect the quality of life. The lesions can result in scarring and the number of days in isolation can also be distressing. All scabs must have dried up and fallen off with new skin forming before a person can leave isolation.

5. Can I get monkeypox from surfaces?

Many common questions involve hard or soft surfaces, and you may wonder if you need to be sanitizing everything you touch. The answer would be no, not unless you live with, sleep with or care for an infected person. "While the virus has been isolated on surfaces in the rooms where patients who have monkeypox have spent long periods of time, contact with the virus on these surfaces does not always result in transmission." says Dr. Bares. "The highest risk may be on the objects in close contact with an infected person for the longest time, such as sheets and other high contact surfaces." 

There have not yet been reports of spread from casual public contact. In places like public pools, hotels, toilet seats, planes, public transportation, laundromats and the like, a person is generally safe due to sanitation practices, chemicals and hot water washing. 

6. How can I protect myself?

• Keep up with thorough and frequent hand washing and sanitizing, especially after contact with animals or someone who is sick. Keep up to date with current recommendations as they adjust. Some guidance may change as we learn more
• Avoid sex and other intimate contact with multiple or anonymous partners
• If you belong to a group potentially at higher risk, limit the number of sexual partners and seek out a vaccine 
• If you experience a new rash, genital or anal lesions, fever or fatigue, reach out to your doctor to find out how to get tested 

7. Is there treatment for monkeypox?

There is no specific treatment approved for monkeypox. Most people get better on their own without treatment, but if symptoms are severe, you may be eligible for an antiviral therapy that is currently approved for smallpox (tecovirimat or Tpoxx). Tpoxx is not approved for monkeypox and is not widely available but can be provided at the discretion of your provider. Talk to your provider for the best course of treatment.

8. How do I get tested?

Currently, testing is only being performed in public health labs. If you suspect you may have monkeypox:

• Isolate from others
• Call your primary care doctor and describe your symptoms. Your doctor can help guide you on where to go for testing 

9. Is there a monkeypox vaccine?

The Jynneos vaccine is licensed by the FDA and is a live virus that can't cause the disease. It is limited in supply and not yet available to the general public. Currently, the vaccine is only being administered to those with the highest risk of potential disease development, such as known exposure. It can be given both before exposure as well as after a known exposure (within four days and up to 14 days after exposure). 

If you suspect you may have monkeypox, call 800.922.0000. The call center will direct you to the clinic that is performing testing that day.