Sexual health

Health alert: Monkeypox

What is monkeypox, and do I need to be worried about it? SFAF clinicians share their perspective.

A curiously-named viral infection–Monkeypox–is in the news right now causing concern among public health officials and the general public. The infection is caused by a virus similar to the one that causes smallpox, and is named after the first documented cases in the 1950s which occurred in monkeys.

Although rare outside of Central and West Africa, cases of monkeypox have been reported recently among a handful of gay and bisexual men in Europe, and a few cases have also been reported in the U.S. 

Here, San Francisco AIDS Foundation clinicians Hyman Scott, MD, MPH, medical director, and Jorge Roman, MSN, FNP-BC, AAHIVS, director of clinical services, answer our questions about monkeypox.

What are the symptoms?

People may get flu-like symptoms, including fever, headache, and fatigue. 1-3 days later, people may get a rash on the face, arms, legs (including the palms of the hands and soles of the feet), and genitals. It usually takes around 6 – 13 for symptoms to appear (the “incubation period”). Over the course of the infection, the rash will change: first, it will appear as flat lesions, will progress to raised and firm lesions, then will fill with fluid, and finally will develop crusts which will dry and fall off. 

With recent monkeypox cases, people have developed the rash around their genitals and/or anus (butt) first. Many of these cases were detected at STI clinics, with symptoms that appear like common STIs including syphilis or genital herpes. 

How long are people infectious?

People are infectious when symptoms begin until lesions have healed. This may take 2-4 weeks. 

How is monkeypox transmitted? 

Monkeypox can be passed from person to person in a few different ways, although this was thought to be rare in previous outbreaks. The virus can also be transmitted through respiratory droplets, which means that you can get it by kissing, sharing drinks, or breathing the same air as someone who has the virus. You can get monkeypox through body fluids (it’s not currently known if it can be transmitted through semen or vaginal fluid) and touching the lesions and rash created by the virus can also transmit the virus, as can coming into contact with viral particles that may be present on clothing or bedding used by someone with monkeypox. 

The World Health Organization reports that, “the main way it can spread is through close physical contact, including sexual contact, with someone who has monkeypox.” 

Are gay and bisexual men at higher risk?

This infection has occurred among some men who have sex with men in Europe, so public health officials have shared this association which was identified during case investigations. Monkeypox can affect anyone, however, and there’s no specific biological reason for men who have sex with men to be at any higher risk. 

Like any transmittable infection, a higher “risk” might simply come from being part of social or sexual networks that include other people who have the infection. For cases that occurred in Europe, the World Health Organization has linked transmissions to two Queer events–one in Spain and the other in Belgium.   

How do I get tested for monkeypox?

If you have a rash on your genital and/or anal area, and/or on face, hands/feet, and other areas of the body, we can test the rash to see if it might be caused by monkeypox or a different infection. Call us or make an appointment at Magnet

How is it treated? 

There isn’t any specific treatment for monkeypox infection, but healthcare professionals can treat the infection with treatments for smallpox and other antiviral medications. 

Is the infection serious?

Many people recover from monkeypox without treatment in a few weeks. The infection can cause severe disease and even death, so treatment is recommended–especially for people who may be at higher risk including people who are immunocompromised, children, and pregnant people. With the strain of monkeypox that is currently circulating, risk of mortality is low (less than 1%). 

What should I do if I develop a rash?

There are many different causes of rashes, and at this point, monkeypox is extremely rare. Contact your primary care provider if you have symptoms or an unexplained rash, or come see us at Magnet to get tested for Monkeypox. SFAF’s clinic, Magnet, is available for diagnosis and treatment for people that develop rashes around their genitals or anus that may be caused by monkeypox or another infection. 

What else should we know?

With festival season, Pride, and summer events approaching, it’s a great idea to check in on your sexual health! We recommend regular sexual health care visits and STI testing for people who are sexually active. Although monkeypox is rare, many STIs including gonorrhea, chlamydia, and syphilis are much more common. Visit Magnet for your sexual health care needs. 

About the author

San Francisco AIDS Foundation

San Francisco AIDS Foundation promotes health, wellness and social justice for communities most impacted by HIV through sexual health and substance use services, advocacy, and community partnerships. Each year more than 21,000 people rely on SFAF programs and services, and millions more access SFAF health information online.
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