MPV: Monkeypox Information and Symptoms

MPV can be acquired from skin-to-skin contact, contaminated linens/clothes, and possibly respiratory droplets.

MPV is not thought to be easily transmissible like COVID. It is mainly transmitted by direct contact with infectious sores, scabs, and body fluids, but skin-to-skin contact is a risk even if not directly touching a sore or lesion. There have been reports of indirect transmission with infected surfaces/materials, such as clothing and linens contaminated with MPV. MPV is also thought to be spread by large respiratory secretions such as those exchanged during prolonged close face-to-face contact, such as kissing, and massages. It is possibly concentrated in semen, so safe sex using condoms is recommended to decrease risk of infection. Wearing a condom is advised for 12 weeks after infection to prevent spread to others.

MPV most commonly starts with flu-like symptoms, followed by a painful rash or lesions. The rash usually develops after one to three weeks from exposure.

A rash, which almost all people get with MPV, can develop before flu-like symptoms (fever, chills, muscle aches, headache, and swollen lymph nodes). The rash usually occurs within 21 days of exposure, most commonly within a week, but two of every 100 people with MPV may develop symptoms even 3 weeks after exposure. People are contagious for several weeks until all skin lesions are healed, scabs have fallen off, and a fresh layer of skin has formed. Thus, in addition to notifying all contacts, people with MPV should stay at home until the lesions are completely healed.

While some cities in the U.S. are starting to immunize high-risk groups, the supply is very limited. Currently, only those with a known close exposure can be immunized in the Dallas area. If available, you would need to get the vaccine directly through Dallas County Health and Human Services, for example.

The DCHHS phone number is 214-819-2004 extension 6 and the website is https://www.dallascounty.org/departments/dchhs/monkeypox.php.

Prism Health North Texas and Uptown Physicians Group have approved MPV tests. If you think you have MPV (a rash or an exposure followed by fever, aches, etc.), you should stay at home and call us or your local primary care provider for an appointment. As MPV is contagious, PHNTX and UPG will likely initiate care with a telemedicine appointment if you have been exposed or think you may have MPV. We can then arrange testing for you.

Treatment for MPV is very limited, but people are recovering in about 2-4 weeks without treatment.

Typically, people recover from MPV without treatment within 2-4 weeks. You should isolate yourself from your pets, as it may be possible to pass to them. Caregivers should wear a mask, gloves, and all linen/clothes should be considered infectious. People at higher risk of complications include those with cancer, that take medications that reduce the body’s ability to fight infections, and those with advanced HIV infection. People living with HIV who are virally suppressed are not thought to be susceptible for more severe disease symptoms. A medication, TPOXX/Tecovirimat, is approved for smallpox, but it has not been studied well for MPV. Per the Centers for Disease Control and Prevention (CDC), it can be considered for severe cases requiring hospitalization and for people whose immune system is vulnerable. Again, people with HIV with an undetectable virus are not thought to be susceptible to severe illness. Currently, the medication is only available through health departments, and the treating physician must complete forms indicating the medication is for compassionate use. PHNTX is working with the local health department in North Texas to streamline this process.

Gay and bisexual men are currently being affected by MPV, but not exclusively. There is nothing about being gay or having sex with men that uniquely makes someone susceptible to MPV infections. At the time of this guidance, infections are happening from events and festivals where activities include dancing and situations where people are having close, skin-to-skin contact with other people.

Everyone is susceptible to MPV infection. People who were born in the U.S. prior to 1970 may have some protection from receiving the smallpox vaccine, but this protection does wane with time, and there have been documented cases of people previously being immunized against smallpox contracting MPV. This is a public health problem that can impact anyone involved in activities where people are having close, skin-to-skin contact with a person with MPV.

Yes, but MPV infections are happening from other skin-to-skin contact in addition to sex. MPV cases are happening after casual skin-to-skin contact like dancing, hugging, massages, and kissing.

The only way to know if someone has MPV at this time is to swab a visible lesion and have the sample tested in a laboratory. Only if you have a visible rash, sore, or blister will we be able to determine whether you have MPV.

Attending a large gathering or event by itself is not the actual risk, but it is important to avoid activities where you may have skin-to-skin contact with others.

Unless there is a visible rash, sore, or blister it will be hard to tell. Someone with a rash, sore, or blister, on or near the genitals should refrain from having sex or intimate contact until the lesions are well healed. Some MPV infections are very mild with only a few small lesions. Ask about rashes or lesions before having sex or intimate contact.

We are waiting for more MPV vaccines to arrive in the Dallas, North Texas area. Once PHNTX and UPG receive them, we will notify who can sign up and how.

PHNTX and UPG recommend that you go to the CDC’s website and review the resources for social gatherings, safer sex, and MPV.

Different things can cause similar lesions, so it may be hard to tell. If you have any new or unexplained rash or blisters, it is important to get checked by a healthcare provider and to avoid casual or intimate physical contact until MPV is ruled out.

Currently, cases are rare, so now is the time to mobilize awareness and prevent the spread of MPV before it gets out of control. Preventing the spread by avoiding high-risk situations like sex parties right now will allow us time to get vaccines which will better protect our community.

During isolation at home, people with MPV should clean and disinfect the spaces they occupy and surfaces with which they regularly come into contact to limit household contamination. Pox viruses can survive in linens, clothing, and on environmental surfaces, particularly when in dark, cool, and low humidity environments. People who have recovered from MPV and whose isolation period has ended should conduct a thorough disinfection of all the spaces within the home that they had been in contact with. Gather contaminated clothing and linens before anything else in the room is cleaned. Do not shake the linens as this could spread infectious particles. (Source: Centers for Disease Control and Prevention)

Treatment for MPV should be offered, when indicated, to people who are pregnant, recently pregnant, or breastfeeding.

The benefits of skin-to-skin contact and rooming-in on breastfeeding and the normal functions of an infant are well-known. However, given the risk of neonatal transmission of MPV with close contact and the potential for severe disease in newborns, direct contact between a person with MPV and their newborn is not advised. It is unknown if MPV is present in breast milk. Breast milk expressed from a person who is symptomatic or isolated should be discarded and breastfeeding should be delayed. People who are breastfeeding should talk with their healthcare provider to determine if their lesions have healed and they can resume direct breastfeeding or feed expressed breast milk. (Source: Centers for Disease Control and Prevention)