About MPXV (Monkeypox)
What is MPXV (Monkeypox)?
Monkeypox is a rare viral infection that does not spread easily between people and is usually associated with travel to Central or West Africa, where it is endemic.
Cases of monkeypox have been identified in several non-endemic countries, including Australia and several European countries and the United States. We also have a recent cases of monkeypox in Queensland with a change of further and increasing local community transmission.
It typically begins with influenza-like illness and swelling of the lymph nodes, then progresses to a widespread rash on the face and body.
MPXV is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases can occur.
How is MPXV Transmitted?
Transmission is through skin-to-skin contact with sores and/or scabs and/or bodily fluids from someone with MPXV.
MPXV MAY not be a sexually transmitted infection, but it seems it can be transmitted like one (likely because of the close contact that comes with sex). You should monitor for symptoms and get vaccinated as early as possible.
Person-to-person transmission of MPXV can occur in several ways:
MPXV is thought to get into your body by direct contact with MPXV sores, scabs from MPXV sores that are healing, or body fluids from a person with MPXV. This tells us that MPXV would spread pretty well during activities that include close, personal contact with a person that has MPXV like sex, cuddling, etc. Breaks in the skin or breaks in the pink parts just inside the mouth, anus, or genitals (mucous membranes) are potential ways MPXV enters the body. These breaks usually occur from the friction of sex.
MPXV might also get into your body through touching materials or objects that a person with MPXV has come into contact with, such as clothing or bed sheets, etc. However, it is unclear whether this is a common way of getting MPXV. At this stage, this is considered a possible risk.
MPXV might also get into your body through breathing air from other people coughing, speaking, or other activities that blow air out of the lungs and throat – although, really long periods of face-to-face contact with someone with MPXV might be required for this to occur. We do know that samples of MPXV sores on the skin appear to contain much more MPXV DNA than throat swabs – suggesting MPXV getting into your body through the air might be less of a risk. But activities where you could possibly inhale MPXV – like shaking bed sheets with MPXV – may also put you at risk and should be avoided.
You can reduce your risk of contracting MPXV by:
- Avoiding contact, including sexual contact, with people who are unwell or have compatible symptoms
- Avoid skin-to-skin contact, particularly with any rash or lesions
- Avoid contact with clothing, bedding or objects that have been in contact with or used by people with MPXV
- As always, practice good hygiene, self-isolate if unwell and seek medical attention if you develop any symptoms
What are the Symptoms of MPXV?
Something as benign as a pimple could be MPXV.
MPXV can start as a general illness that seems like a cold that develops into a rash of disk-like pimples that covers areas of your body.
Symptoms include a fever, headache, muscle aches, low energy, swollen lymph nodes and a skin rash or lesions (these are similar to COVID or the flu).
These pimples will then crust over, become sores, and eventually your skin will heal. This process usually takes two to three weeks to complete.
How long does it take to show up?
Prior to the current global outbreak, it usually took about 5 to 13 days after MPXV got into your body for symptoms to show up – but symptoms can develop in just 4 days or take as long as 21 days to show. With the current global outbreak, it has usually taken 7 to 10 days for symptoms to appear.
What symptoms should I look for?
A general, unwell feeling is sometimes experienced in the early stages of having MPVX. At this early stage, it is hard to tell if you have MPXV, as these symptoms can be caused by other things that aren’t MPXV – like COIVD, the flu, some STIs, etc. The things to look out for in this early stage are a fever, a sore throat, back pain, a headache, and feeling fatigued. Sometimes, people don’t get any symptoms at all in the early stages and feel perfectly fine.
A rash: a rash of small (2 – 5 mm) disks that look like pimples that show up on any part of the body. Often, these pimples are found on or in the genitals, on and/or around the anus, or in the mouth.
Sometimes the rash will show up on the face, arm, chest, and legs. This rash can show up one or two days before, or three to four days after the general feeling of sickness described above. But remember, sometimes people don’t feel sick, and they experience just the rash. Ultimately, the rash will last for about two to three weeks after it first shows up and develops into sores that crust over and fall off. Images of the rash can be found here.
In the current global MPXV outbreak, there have been cases of people with sore throats who report they have difficulty swallowing. There have also been cases of MPXV that caused sores on and around the anus, with rectal bleeding, pain, and inflammation. It is best to seek medical care from one of these GPs or your local sexual health clinic if you experience these symptoms.
How long can MPXV be passed on if someone has it?
If you have MPXV avoid sexual contact with other people until symptoms resolve.
If you have been told you are contact with someone with a confirmed case of MPXV, avoid sexual contact for 21 days and monitor for symptoms.
MPXV can be passed on whilst someone has symptoms: that is from when symptoms first appear and all the way through until the skin has healed completely – looking just like it did before the MPXV rash.
Is MPXV Treatable?
Most MPXV is mild and can be treated at home with drinking enough water, taking paracetamol or ibuprofen, and rest.
Serious cases can be treated by a doctor with special training in infectious diseases.
Most people experience a mild illness, and if this is you, all you have to do is rest, make sure you’re drinking enough water, and manage pain and fever with paracetamol or ibuprofen. Getting better usually takes a few weeks.
Severe illness and/or for people with weakened immune systems
Some treatment options exist; however, this requires the expertise of a doctor that has special training in infectious diseases. If this is you, it is best to consult your GP or sexual health service to find out more.
Because MPXV is closely related to the virus that causes smallpox, the smallpox vaccine can protect people from getting MPXV. Vaccines are often encouraged for persons at greatest risk of getting MPXV.
It’s important we all continue to be self-aware of our health, remain vigilant for symptoms and take precautions as needed.
Because of the close contact with other people that comes with having sex, it is possible that MPXV could get into your body during sex if one or more of your sexual partners have MPXV.
At this time, sexual contact with multiple partners presents a higher likelihood of MPXV transmission. As we wait for more vaccines to arrive, consider reducing your sexual partners for the time being. This will lessen your risk of exposure to MPXV.
Consider limiting your hook-ups to people you know. Creating a bubble will reduce the likelihood of exposure to MPXV. Remember: this is not forever and that it’s only temporary. But this will help slow the spread of MPXV.
Easy ways you can reduce your risk from MPXV, and slow the spread in our community include:
- Sharing your details and phone number with your partners so they can let you know if they come in contact with MPXV or develop symptoms. This will allow you to can access PEP if needed.
- Reduce your number of sexual partners
- Consider limiting your sex partners to people you know. Creating a bubble will reduce your risk of acquiring MPXV.
- Not sharing your sharing sex toys with others
- Having virtual sex through the phone or a webcam without personal contact
- Masturbating together without personal contact
- Using condoms for 8 weeks after recovering from MPXV.
- Keeping your clothes on to minimise skin-to-skin contact
- Avoiding kissing
- Get vaccinated when possible
Been or Going Travelling?
Are you a returned traveller from places with MPXV outbreaks and you hooked up or attended sex parties, saunas or sex clubs while away? Then reduce your hook-ups when you get home. It is recommended that you hold off from sex for 14 days so you can monitor your health. If symptoms develop, seek medical attention immediately.
If you are planning to travel, it is important to stay informed and remain aware of developments. The situation with MPXV is changing rapidly.
- Follow public health alerts and advice from local health authorities of the countries/areas you are visiting
- If visiting festivals or large events, stay abreast of event updates (before and after) from organisers.
Been a Close Contact?
Contacts of people with confirmed cases of MPXV should avoid sexual contact for 21 days and monitor for symptoms.
If you have been identified as a close contact of someone who has tested positive for MPXV, you will receive a call from Queensland Health’s Public Health team. Follow the Public Health team’s recommendations, including instructions on limiting your movements, and if and when and how to attend a sexual health service for review.
If you think you have symptoms of MPXV, isolate at home and seek medical care by calling a sexual health clinic, a GP that has a lot of experience in sexual health (a list is found here), or call 13 HEALTH (13 43 25 84).
It would be best to isolate at home but note you can leave to seek medical care in an emergency or any other situation that poses a risk to your safety and wellbeing. Medical advice for MPXV can be sought by calling these doctors (they will likely offer a telehealth appointment), calling your local sexual health clinic, or by ringing 13 HEALTH (13 43 25 84).
If you live with other people, if possible, it would be best to isolate yourself in a room or area that is separate from the rest of your household. If this isn’t possible, you can minimise the risk of transmission by wearing longer clothing that covers the body and by wearing a face mask. Regular hand washing, wearing gloves for direct contact, and cleaning common surfaces will minimise the likelihood of passing MPXV to the people you live with.
Follow instructions from your health care practitioner during your self-isolation and recovery. If you are living with HIV and require support, please contact us, we are here to help, but do contact 13 HEALTH or your local clinic first.
People who have contracted MPXV should not engage in any sexual activity while infectious. Avoid kissing and touching each other’s bodies – especially any rash or sores. Do not share things like sex toys or fetish gear during this time. And because it is not known how long MPX remains present in semen and other genital excretions, people who have recovered should use condoms for eight weeks after recovery. This is a precaution to reduce the risk of spreading infection to sexual partners.
MPXV in Queensland
As of the 23/09/22 we now have community transmission in Queensland with the potential for further local transmission in Brisbane. Now is the time that everyone should know what to look for, and how to reduce their risk of MPXV.
HIV and MPXV
We know that people living with HIV do make up a higher than expected number of cases from outbreaks in Europe and the Americas. Why this is isn’t well understood, as most is based on research in countries where access to HIV treatment is low, which is very different to how we manage HIV in Australia.
At the moment people living with HIV should follow the same advice as the general population.
Should evidence emerge that people with suppressed immune systems are at greater risk of MPXV, or ill-health from catching the virus, then updated information and advice will be made available.
We would encourage any person living with HIV, who is planning to travel to a current MPXV hotspot to speak with their s100 prescribing doctor or your local sexual health service for advice and vaccination when it is available.
There is a safe and effective vaccine, named JYNNEOS, which protects people against MPXV. However, because there has been MPXV in a lot of different parts of the world, everyone wants this vaccine right now – so it is hard to find the stock.
If you would like to be vaccinated for MPXV we recommend calling your local sexual health clinic and ask to be put on the waiting list.Please be patient, and try and contact them in an off-peak time, as they are especially busy at this time, as well as contact tracing.
Vaccination can also be offered to people that have had sexual partners with confirmed MPXV cases. This should help ensure the illness is milder or reduce their chance of developing symptoms altogether. This is known as PEP (post-exposure prophylaxis).
The vaccine used for MPXV(monkeypox) is JYNNEOS – Bavarian Nordic (BN) product that is safe to use in people who are immunocompromised, which includes some people with HIV.
This vaccine is a two-dose vaccine, with at least 28 days between each dose. People will start to build protection in the days and weeks after their first dose but will not have full immunity from the vaccine until two weeks after the second dose.
There is extremely limited supply of the vaccine in Queensland, the vaccine will only be available by joining the waiting list, or when prescribed directly by a doctor.
Once more vaccine is available, a staggered rollout will take place, to protect those at greatest risk first. Queensland Health is working with a range of clinical services and partner organisations to identify people most at risk of infection so they can be prioritised for vaccination.
Health authorities are asking us to be please be patient as they work through vaccine distribution across Queensland. Vaccines will be available initially through Queensland Health facilities and s100 prescribing GP’s. As more vaccine doses arrive in Australia, the vaccine rollout will be expanded and we will inform you of the clinics involved in the rollout and other arrangements including for people who are ineligible for Medicare.