Monkeypox is a virus similar to smallpox, but symptoms are less severe. It was discovered in 1958 after outbreaks occurred in monkeys kept for research. Scientists suspect the virus circulates in a variety of primates and rodents in the wild. The virus has occasionally caused small outbreaks in other parts of the world, including the United States, but it is primarily found in parts of Central and West Africa. In recent weeks, it has spread to dozens of countries and infected tens of thousands of people.
The virus, which has a low fatality rate, is known to spread through physical contact, and through infected items like clothing and bedding or by the respiratory droplets produced by sneezing or coughing, according to the World Health Organization.
Monkeypox can also be transmitted from mother to fetus via the placenta or during close contact during and after birth.
A majority of cases this year have been in young men who ,say they have sex with other men, though there is little evidence that monkeypox transmission occurs through semen or other bodily fluids exchanged during sex. Contact with infected lesions during sex may be a more plausible route, but scientists are still investigating other possibilities.
The monkeypox virus can spread from person to person through close physical contact with infectious lesions or pustules, by touching items — like clothing or bedding — that previously touched the rash, or via the respiratory droplets produced by coughing or sneezing.
Monkeypox can also be transmitted from mother to fetus via the placenta or through close contact during and after birth.
It is unclear whether monkeypox is also transmitted sexually, though in a study of more than 500 cases that were reported in 16 countries between April and June, researchers found that 98 percent of monkeypox cases were among men who have sex with men. Researchers in another study found evidence of monkeypox virus D.N.A. in saliva, urine, feces and semen, but they do not yet know if the virus found there is able to replicate and infect another individual.
Some experts and academics are concerned about the stigma that comes with labeling monkeypox a sexually transmitted infection. Others argue that it is important to acknowledge sex as a possible risk factor in order to help those who are most vulnerable right now — men who have sex with men.
Anyone can potentially catch and transmit monkeypox, but the number of cases in women and children has remained relatively small, even as testing has expanded around the globe.
Currently, the risk to the general population is pretty low. People are unlikely to get monkeypox in shared spaces like schools and offices, or by trying on clothes in stores, as some social media posts have suggested, said Dr. Seth Blumberg, an expert in infectious diseases at the University of California, San Francisco.
Other evidence also points to sex as a likely route of transmission. Many cases in the recent outbreak have involved presentation of lesions or pustules on genital regions, rather than the classic flu-like symptoms of monkeypox followed by a body-wide rash. Several small studies have also found monkeypox virus DNA in semen and other bodily fluids collected from patients, although it is not clear yet whether the virus found there is able to replicate and infect another individual.
As a precaution, some public health experts have suggested that those at risk of monkeypox temporarily reduce their number of partners to reduce their risk and avoid sex if they do get sick. The W.H.O. has also updated its guidance to recommend that those who have a confirmed or suspected monkeypox infection use condoms during sex for 12 weeks after they have completely recovered to reduce the risk of spreading monkeypox to partners.
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As monkeypox spreads across the United States, it may be giving people flashbacks to the days of wiping down counters and groceries to get rid of the coronavirus. But for most people, the risk of getting monkeypox remains low. Almost all cases in the current outbreak — 98 percent — have been in adult men who have sex with men.
So how is the virus spreading? Studies of previous outbreaks suggest that the monkeypox virus is transmitted in three main ways: through direct contact with an infected person’s rash, by touching contaminated objects and fabrics or by respiratory droplets produced when an infected person coughs or sneezes. There is also evidence that a pregnant woman can spread the virus to her fetus through the placenta.
Scientists are still trying to understand if the virus can spread through semen, vaginal fluids, urine or feces and if people can be contagious before they develop visible symptoms.
Several factors can determine your risk of getting monkeypox, whether from caring for someone who is ill to attending packed parties or simply having sex. How close you are to someone who is sick, how infectious they are, how much time you spend in their vicinity and your own personal health may affect your susceptibility, said Dr. Jay Varma, a physician and epidemiologist who specializes in infectious diseases at Weill Cornell Medical School in New York City.
Here is how experts are thinking about everyday interactions, how the virus is transmitted during them and which behaviors carry the most risk.
High risk
The activities that put a person at highest risk of catching the virus involve close, intimate contact with another infected individual. This includes the kind of skin-to-skin contact that occurs during sex, as well as when cuddling, hugging, massaging or kissing another person. Condoms probably add a layer of protection during sex, but they are unlikely to prevent contact with lesions on an infected person’s groin, thighs, buttocks or on other parts of their body.
Roommates and family members in the same house are also at significantly higher risk of getting monkeypox compared to any other individuals a patient may come into close contact with, said Dr. Bernard Camins, the medical director for infection prevention at the Mount Sinai Health System.
Household contacts can catch monkeypox through contaminated clothes, towels and bedding. Shared utensils that may carry an infected person’s saliva should also be considered high risk, said Saskia Popescu, an infectious disease epidemiologist at George Mason University.
Medium risk
When it comes to respiratory droplet transmission, face-to-face or almost face-to-face contact is riskier than being several feet away. Health officials recommend maintaining at least 6 feet of distance from unmasked patients to avoid getting exposed, although some experts argue that this number is arbitrary. Still, just as with Covid-19, masking up indoors is a good idea if you want to protect yourself from monkeypox. Attending a packed indoor party could put you at risk of getting the virus, particularly in parts of the country where cases are high. Raves where people are having direct, skin-to-skin contact, dancing together for a longer duration of time may be riskier still, Dr. Popescu said.
Lower risk
People are unlikely to get the virus by trying on clothing in a store or touching nonporous items like door handles and counters, Dr. Popescu said. “Personally, I’m less concerned with trying clothing on in the store,” she said. For those who are really nervous, she suggested just putting a new item in the laundry when they get home for some peace of mind.
Additionally, some activities that people learned to limit during Covid-19 surges are probably not as risky for monkeypox transmission. For example, sitting on a subway, bus or other public transportation or going to an office or school are unlikely to put people at risk of a monkeypox exposure. But experts caution that this guidance could change as researchers gather more data on monkeypox. If the virus keeps spreading unchecked, it could eventually spill over to a broader population, increasing everyone’s chances of an infection. But, Dr. Camins said, “We’re not there yet.”
Audio produced by Kate Winslett.
Monkeypox is part of the same family of viruses as smallpox, but it is typically a much more mild condition, according to the Centers for Disease Control and Prevention. Based on what scientists have learned from past outbreaks in African countries, people typically develop symptoms of monkeypox within six to 13 days of exposure, but they can take up to three weeks. People who get sick commonly experience a fever, headache, back and muscle aches, swollen lymph nodes and general exhaustion.This is followed by a painful rash that is characteristic of poxviruses. It starts with flat red marks on the patient’s face, hands, feet, mouth or genitals that become raised and filled with pus over the course of about a week.
Experts have noted that monkeypox symptoms may look different in recent cases. People who get sick do not always have the traditional fever, aches and body-wide rashes. Many patients have developed only a few pustules, in the genital or rectal area, which can easily be mistaken for other sexually transmitted infections. And at least one study has detected the virus in individuals who did not experience any symptoms at all.
Symptoms usually go away on their own or with a little supportive care, like medication for pain or secondary infections. People are no longer infectious once their pustules scab over and the scabs fall off, , said Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada.
Children and people with underlying immune deficiencies may have more severe cases, but monkeypox is rarely fatal.
If you start to notice red lesions, pimples or pustules, you should contact your primary care physician and let the physician know that you suspect a monkeypox infection. Your doctor will swab a lesion and order a monkeypox test for you. You can also be tested at urgent care centers or sexual health clinics or through other health providers.
If you don’t have any symptoms or have only fever and flulike symptoms, there is no way to test for monkeypox yet, said Dr. William Morice, the chair of the department of lab medicine and pathology at Mayo Clinic and president of Mayo Clinic Laboratories. There is no home test for monkeypox. And even at a clinic, health care workers need a lesion to swab in order to perform a test, Dr. Morice added.
Patients should isolate at home as soon as they develop monkeypox symptoms. They should also cover all skin rashes as much as possible, and, like those with Covid-19, avoid close contact with friends, family members and pets and wear high-quality masks if they must come in contact with others for medical care. The C.D.C. recommends limiting exposure to others and staying in isolation until any lesions are completely healed. You’re out of the woods only after lesions crust over, scabs fall off and a fresh layer of intact skin has formed. And that can take a long time — anywhere from two to four weeks.
The vaccine that is most commonly used for monkeypox is called Jynneos. It consists of two doses given four weeks apart. But because its supply is limited in the United States and is controlled by the U.S. government, it is not widely available to the American public.
According to the Centers for Disease Control and Prevention, people who are eligible for vaccination include:
People who have been identified by public health officials as a contact of someone with monkeypox.
People who may have been exposed to monkeypox, such as:
The vaccine can work even if it is given after someone is exposed, and the Centers for Disease Control and Prevention recommends that people be vaccinated within four days of the date of exposure for the best chance of preventing monkeypox. You can schedule an appointment for the vaccine through your local or state health department.
Getting vaccinated between four and 14 days after an exposure can also help reduce symptoms, though it may not prevent the onset of disease.
The Food and Drug Administration announced on July 27 that it had cleared nearly 800,000 additional doses of vaccine for use. The doses were withheld pending an F.D.A. review, which has been completed.
American officials have ordered nearly seven million doses, which will arrive in batches over the next months. So far, the administration has shipped about 320,000 doses to states.
But more vaccine doses will be needed, as several cities have expanded their criteria for immunization against monkeypox to include sex workers, patients of sexual health clinics, clinicians and other staff members who may be exposed to the virus at work.
After a diagnosis, monkeypox treatment mainly involves managing symptoms, said Dr. Bernard Camins, the medical director for infection prevention at the Mount Sinai Health System. Patients with anal or rectal lesions may experience a lot of pain, especially while defecating, and in those cases, a doctor may prescribe pain killers or recommend stool softeners and shallow sitz baths, used to relieve pain or itchiness in the genital area, he said. Patients with sores in their mouth may have difficulty swallowing and can use medication to help. Some may develop secondary bacterial infections and require antibiotic treatment, especially if they have large, open lesions.
Antivirals such as tecovirimat, or TPOXX, are typically recommended only for people who have more systemic symptoms, like a fever, headache, swollen lymph nodes or a bodywide rash and are at high risk for complications from monkeypox. Doctors must request the drug from the government’s stockpile, fill out extensive paperwork and get patients’ informed consent in order to obtain the treatment.
“It’s not a medication that is sitting on the shelf in the pharmacy or in the clinic,” said Dr. Sandro Cinti, an infectious disease physician at the University of Michigan in Ann Arbor.
Regardless of whether they are able to receive antiviral treatment, patients should isolate at home as soon as they develop monkeypox symptoms. They should cover all skin rashes as much as possible, and, like those with Covid-19, avoid close contact with friends, family members and pets, and wear high-quality masks if they must come in contact with others for medical care. The C.D.C. recommends limiting exposure to others and staying in isolation until any lesions are completely healed. You’re out of the woods only after lesions crust over, scabs fall off and a fresh layer of intact skin has formed. And that can take a long time — anywhere from two to four weeks.
The United States has reported more monkeypox cases than any other country in the world. As people recover from their infections, they’ll naturally want to avoid a repeat infection and repeat episodes of the pain and fear associated with the disease.
The good news is that experts believe you are not likely to become reinfected with monkeypox after you’ve been infected or vaccinated.
Based on what scientists know of other orthopox infections — such as smallpox, monkeypox’s close cousin — immunity to the disease should be lifelong. In studies of smallpox survivors, researchers have noted that immune cells that help coordinate the body’s ability to fight off the virus and kill infected cells can still be found in people’s blood up to 83 years after their original smallpox infection. Similarly, antibodies that are able to neutralize the smallpox virus seem to stick around for decades after an infection.
That’s the case for most viral diseases, according to Paula Cannon, a professor of microbiology and immunology at the Keck School of Medicine at the University of Southern California. Viruses that tend to mutate slowly — like measles, mumps or the Epstein-Barr virus, which causes mononucleosis — also prompt a strong immune response. As a result, immunity after infection tends to be lifelong. Your body learns to recognize the virus and remembers how to fight it in case of future encounters.
Upper respiratory illnesses such as the flu, the common cold and Covid are notable exceptions. The viruses that cause these illnesses adapt quickly, with mutations that make them significantly different from what the body may have dealt with in the past — as we all learned with the Omicron variant of Covid. These pesky pathogens also stay in and infect your nasal passages, throat and upper respiratory tract, where the body does not usually treat invaders as a big threat.
A monkeypox infection is very likely to create an immune response more similar to that of smallpox than to that of Covid, Dr. Cannon said. “I would also expect that to be long term or for life,” she said.
As with the original smallpox vaccine, the current Jynneos shots authorized for monkeypox are also based on a weakened form of a related virus called vaccinia virus, Dr. Cannon said. “So you basically get an asymptomatic or incomplete infection, which will provide you with pretty high and complex levels of immunity.”
Some epidemiologic data from vaccinia virus inoculations for smallpox suggests that getting vaccinated provides dependable protection for at least five years, with some level of immunity lasting 10 years or more. When researchers looked at antibodies after vaccination, they found that levels remained comparable to those in individuals who recovered from smallpox even after several decades.
But when it comes to monkeypox, there is limited real-world data, as it is a new viral infection in nonendemic countries. It is still possible that six months down the road, we’ll start hearing of rare cases of reinfection, said Dr. David Cennimo, an infectious disease expert at Rutgers New Jersey Medical School.
It’s not out of the question that your immune memory could wane several years after a vaccination or an infection, Dr. Cennimo said. Researchers have observed this after some types of vaccinations, which is why you need a booster for shingles, an illness caused by the same virus that gives you chickenpox. Your immune system could also weaken as a result of taking certain medicines, such as chemotherapy drugs, or undergoing treatments for autoimmune disorders, including multiple sclerosis, lupus or rheumatoid arthritis. Another infection like H.I.V. or the flu could temporarily weaken your immune system. Smoking, alcohol consumption or poor nutrition could also suppress your immune responses.
The Centers for Disease Control and Prevention has long recommended that people get booster doses for smallpox or monkeypox every two or 10 years if they remain at continued risk for infection. In the past, the guidance has only applied to laboratory workers and health care professionals who work closely with the viruses. What happens next, however, will depend on the trajectory of the current outbreak, Dr. Cennimo said. “I couldn’t predict if we’re going to be telling patients getting the monkeypox vaccine now that in three years they’re going to need a monkeypox booster,” he said. “Certainly, if we don’t control this transmission now, and this becomes an endemic infection, that may be the case.”
So far, there has been no evidence of reinfection with monkeypox, Dr. Cennimo said. And if case counts keep falling and monkeypox stops circulating widely, there is hope that booster doses will not be needed. Immunity from the primary vaccination or an infection will continue to protect people for a long time.
Monkeypox lesions start out as flat red marks on the skin that can quickly become raised and filled with pus. In some patients they can look more like mosquito bites, pimples or ingrown hairs than the large pustules usually associated with the infection. But if you do get a rash of any sort, it almost always progresses through a few common stages, ending with blisters that eventually crust over and fall off — a process that can take two to four weeks.
Although the scabs are a sign that the painful infection is about to be cleared, there is a possibility that some patients will still have redness or discoloration afterward that will fade with time, said Dr. Mary Stevenson, an assistant professor of dermatology at N.Y.U. Langone Health. In some cases, people may also be left with permanent scars.
That doesn’t mean that scarring is inevitable. “The vast majority of people will recover from monkeypox and have no discernible long-term effects,” said Matthew Hamill, an expert in infectious diseases and sexually transmitted infections at the Johns Hopkins University School of Medicine.
Based on what experts know from other infection and wound research, people who have a history of healing poorly from other skin conditions or who have developed certain types of scars in the past may be at higher risk of permanent scarring from monkeypox. These include hypertrophic scars, which are raised, and keloid scars, which are raised and thickened and sometimes grow beyond the original wound.
Scars can take the form of depressions in the skin or have firm, raised ridges. While people may be concerned about monkeypox lesions on the face, the skin there tends to heal better than anywhere else on the body, said Dr. Raman Madan, a dermatologist at Northwell Health in Huntington, N.Y. “Most of the scars I’ve seen have been more on the body,” he said.
You can take steps to prevent the formation of scars no matter the location of your monkeypox lesions. The first is to ensure that your lesions don’t get infected by bacteria, which can cause pustules to become aggravated and inflamed. Use an anti-bacterial wash while you have active lesions, Dr. Madan said. Keep lesions covered with a Band-Aid or clothing; this can also help prevent the spread of monkeypox while you are infectious. And though it is easier said than done, try not to scratch your blisters or let scabs dry out.
“It is important to keep your hands off the lesions because just like pimples, picking or scratching the lesions can worsen scarring,” Dr. Stevenson said.
Dermatologists believe that keeping lesions covered with petroleum jelly can help the healing process.
Once the lesions have resolved, wear sunscreen to protect the fresh skin underneath, Dr. Stevenson said. This will help any discoloration fade faster. Some studies have shown that using a medical-grade silicone gel or silicone sheets can also improve general wound healing. Dermatologists believe that silicone mimics the skin’s natural barrier and helps keep moisture in while regulating growth factors and collagen production. You can also apply a topical retinoid cream as long as it is not too irritating, Dr. Stevenson said. Retinoids enhance skin-cell turnover and stimulate collagen formation.
Above all, be patient. Scars can take months to fade, depending on their severity.
After that, there are a few medical and cosmetic procedures — such as laser treatments and surgical scar removal — that can improve your skin quality and texture if preventive measures fail.