Transmitted by direct skin-to-skin or mucosal contact with lesions, body fluids, or contaminated materials (bedding, clothing). Sexual contact is the predominant route in the current global outbreak. Respiratory transmission requires prolonged close face-to-face contact. Animal-to-human transmission occurs in endemic African regions (rodents, primates).
Symptoms
Fever, headache, myalgia, and characteristic lymphadenopathy (often the distinguishing feature from chickenpox or smallpox), followed by a rash that progresses from macules to papules to vesicles to pustules to crusts over 2–4 weeks. In the current global outbreak, lesions are often genital, perianal, or oral and may be limited in number. Severe disease occurs in immunocompromised patients, young children, and pregnant women.
Treatment
Mostly supportive — analgesia, wound care, and isolation until lesions fully heal. Tecovirimat (TPOXX) is reserved for severe disease, immunocompromised patients, pregnancy, or lesions in anatomically sensitive areas; clinical trial evidence has been mixed. Brincidofovir and vaccinia immunoglobulin are second-line options.
Endemic regions
Endemic in Central and West Africa with historical clade I (more severe) and clade II (less severe) circulation. Since 2022, clade IIb has caused a sustained global outbreak primarily affecting men who have sex with men. Since 2024, clade Ib has emerged with sustained transmission in the Democratic Republic of the Congo and surrounding countries (Burundi, Rwanda, Uganda, Kenya), with travel-related cases reported worldwide.
Prevention & prophylaxis
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JYNNEOS / Imvanex (modified vaccinia Ankara)
2 subcutaneous doses, 28 days apart. Recommended for: men who have sex with men with multiple recent partners; sex workers and their clients; healthcare workers caring for confirmed cases; laboratory staff handling orthopoxviruses; close contacts of confirmed cases. Approved from age 18 (used off-label in adolescents in outbreak settings). A non-replicating vaccine — safe in immunocompromised individuals, unlike older smallpox vaccines.
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Sexual health and risk reduction
During active outbreaks, reduce partner numbers, avoid sex with anyone who has unexplained rash or sores, and have open conversations about recent symptoms or exposures. Condoms reduce but do not eliminate transmission risk (skin-to-skin contact at uncovered sites can still transmit). After mpox infection, wait until all lesions have fully crusted, fallen off, and new skin has formed before resuming sexual activity (typically 2–4 weeks).
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Travel to endemic areas
In endemic African regions (Central and West Africa) avoid contact with rodents and primates, do not handle bushmeat, and avoid eating undercooked wild game. Healthcare workers travelling for clinical work in outbreak settings should be vaccinated and use full PPE. Routine tourist travel to endemic countries does not require vaccination unless other risk factors apply.
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Post-exposure vaccination
JYNNEOS given within 4 days of exposure may prevent disease; given within 4–14 days it may attenuate severity. Indicated for high-risk contacts of confirmed cases. Seek medical attention urgently if you've had close contact (sexual, household, or healthcare) with a known mpox case.
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⚠ Symptoms after possible exposure
Incubation 5–21 days. Watch for fever, swollen lymph nodes, and a vesicular/pustular rash — in the current outbreak often starting in the genital, perianal, or oral area before spreading. Seek medical attention promptly, isolate from others (including pets), and inform the clinic in advance so they can prepare PPE.