Monkeypox is dominating headlines across the world as cases continue to spread. To date, there is one confirmed case of monkeypox in the U.S.—in Massachusetts, specifically—and more suspected cases in New York, Florida, and Utah, according to a press briefing held by the Centers for Disease Control and Prevention (CDC). And as cases increase, it’s understandable to wonder how monkeypox spreads.
“We’re in the early days of this response,” Captain Jennifer McQuiston, deputy director of the CDC’s division of high consequence pathogens and pathology, said during the press briefing. “It’s likely that there are going to be additional cases reported in the United States.”
Monkeypox is not nearly as infectious as COVID-19, says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York, but cases have shown up across the world in areas where the disease isn’t usually seen. Accurate global estimates are tough to come by, but the World Health Organization (WHO) has the global case count at 92 as of May 21.
Ahead, infectious disease experts share everything you need to know about the disease—including how it spreads, monkeypox symptoms, and preventative measures.
How does monkeypox spread?
There has been a lot of question about this lately, given that monkeypox has suddenly shown up in areas where it’s not usually present. While monkeypox is endemic (meaning, it’s constantly around at some level) in central and west Africa, it’s unusual for it to be seen in so many different areas at once.
People typically get monkeypox when they come into contact with the virus from an animal, a person, or materials contaminated with the virus, according to the CDC. The virus can then enter the body through broken skin or the eyes, nose, or mouth. It’s also possible to get monkeypox by being bitten or scratched by an infected animal, or by having direct or indirect contact with body fluids or lesions from infected people.
The ECDC also said that monkeypox has been spread through fomites, which are objects, surfaces, or materials that can carry infectious particles. “Fomites are inanimate objects such as articles of clothing that could harbor a pathogen and can be a route of transmission for monkeypox,” infectious disease expert Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security, says. Even bedsheets can be a fomite, Dr. Russo says. “Bedsheets could become contaminated with a combination of fluid or scabs from a person infected with monkeypox,” he says. “Another person could come into contact with those sheets or bedding through micro-breaks in their skin and become infected.”
While fomites can play a role in the spread of monkeypox, Dr. Schaffner says this is something you’re unlikely to pick up on the street or at the grocery store. “This is not COVID,” he says.
Is monkeypox spread through sex?
But the current global outbreak seems to have a link to sex—although public health officials have made a point to say that monkeypox is not a sexually transmitted infection. The virus has mostly shown up in men who have sex with men and lesions in some cases have been restricted to the genital area, which “suggest transmission occurred during sexual intercourse.” according to the European Centre for Disease Prevention and Control (ECDC).
But Dr. Adalja points out that it’s possible to spread monkeypox through sexual contact without it being an STI. “Sexual interaction involves very close contact and pathogens can use that contact to transmit, even if they are not strictly sexually-transmitted infections,” he says. “Skin-to-skin contact and exposure to respiratory droplets that can facilitate transmission in these encounters.”
An STI usually means that a virus or disease is spread through sexual fluids, like vaginal secretions or semen, Dr. Russo explains. “If you’re being semantically correct, it’s technically not a sexually transmitted infection,” he says. “You could go through that intimate contact without having sexual intercourse and still acquire the infection through the intimate contact with skin and/or respiratory droplets that are produced through kissing.”
“Monkeypox is not a virus that infects the sexual organs the way gonorrhea or syphilis does,” says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. “It’s not the sexual act that is so important, it’s more the skin-to-skin contact.”
What are the symptoms of monkeypox?
Monkeypox has symptoms that are similar to smallpox, although they’re often milder in monkeypox patients. Monkeypox typically lasts for two to four weeks, according to the CDC and usually starts with these flu-like symptoms:
- Muscle aches
- Swollen lymph nodes
A few days after the original symptoms show up, a person will develop a rash that starts on the face and spreads to other areas of the body, the CDC says. (However, Dr. Russo points out, that some people with recent cases of monkeypox have had a rash that is just restricted to the genital area.) The rash usually goes through different phases before it clears. Those include:
- Macules (flat, discolored bumps)
- Papules (raised area of skin)
- Vesicles (blisters)
- Pustules (small bumps that contain pus)
- Scabs (dry, crusty bumps)
How to protect yourself from monkeypox
In general, experts say most people don’t need to worry about monkeypox. “The threat of monkeypox from this outbreak is low to the general public,” Dr. Adalja says. “If there are people who are at risk because of their sexual activities, they should be aware of the fact it is spreading within a sexual network and be cognizant whether or not anyone they’ve been around has lesions consistent with monkeypox.”
Dr. Russo also recommends that you avoid “close intimate contact” with someone who has monkeypox symptoms or that you know has had contact with someone with monkeypox. “It does take a large exposure to get it,” he says. “This is not something you’ll pick up by passing someone on the street.”
Overall, Dr. Russo expects that monkeypox cases around the world will fade soon. “Hopefully this will burn itself out,” he says.
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