Everything you need to know about monkeypox

There’s a lot in the news about monkeypox at the moment and some people might be panicking and others might have their hands over their ears. The first documented cases in the UK were in May 2022, so we are still learning about the virus, how serious it is, how it’s transmitted, what effects it’s having, and who is most at risk. So don’t panic, and don’t run away, here’s what you need to know, in a chilled and informative guide.

What is monkeypox?

Monkeypox is a virus which was originally discovered in 1958, in monkeys. There have been outbreaks in central and western Africa in the last few years, but these have been cases where the outbreaks are from animals to humans. The reason it’s in the news now is that monkeypox is being acquired via human to human contact, which hitherto wasn't typical. Outbreaks are happening around the world but particularly in the UK, Europe, the U.S., and Canada. 

The virus has only infected a relatively small number of people. The UK has one of the biggest outbreaks and we still have a total number of under 3,000 cases since reporting began in May. In the U.S. it’s under 5,000 at the time of writing. So being sensible and informed is the way to go. It’s just good to be aware of what the signs and symptoms are, and what to do about it in order to contain the outbreak.

At the moment it seems to mostly be affecting gay and bisexual men, and men who have sex with men (GBMSM). So it’s affecting the networks of people who have sex with each other (and possibly people they might live with). Thus, sexual health services are reaching out to sexually active gay and bi men, particularly those who have had a new sexual partner recently, in geographic areas (or venues) where monkeypox has been more prevalent. It’s best practice to protect the network of people who, currently, are most likely to get the virus. 

Sidenote: it’s not homophobic or biphobic for health agencies and educators to share this information and to target gay and bi men. To ignore who is currently affected by the virus and to not allocate those resources appropriately would be homophobic and biphobic. The part of the AIDS crisis that was homo/biphobic was governments ignoring the virus for so long, and then when they (and the right wing press) finally started to pay attention, blaming gay and bi men and their behaviour for causing the disease. 

In the largest study yet of the current outbreak the authors write: “[a]lthough the current outbreak is disproportionately affecting gay or bisexual men and other men who have sex with men… [i]t can affect anyone. We identified nine heterosexual men with monkeypox.” There may also be under-reporting of symptoms for people who have less contact with sexual health services generally. So it’s just sensible for us to be informed about monkeypox and to also inform each other about what to look out for. 

Signs of monkeypox

Historically the kinds of symptoms to look out for have been:

• Fever

• Intense headache

• Swelling of the lymph nodes (or glands) (for example, in the neck or in the groin)

• Back pain

• Muscle aches

• Lack of energy 

• Rashes on the face which might spread to the, hands, mouth, or genitals, or the anus

• Followed by blisters that then fill up, dry out, and fall off

Mostly, it’s not a serious virus, and people will usually recover by themselves within two to four weeks. However, the symptoms aren’t pleasant and occasionally might require hospitalisation to treat painful effects. Historically there have been fatalities from monkeypox but this outbreak appears to be milder. We do have a vaccine for Smallpox which would work for this and that is now being rolled out to the people who need it most. 

In this outbreak the latest research suggests that it’s the blisters and rashes that are the most common symptom. These are mostly around or on the genital area and around the anus too. They can also be found inside the anus, in the mouth and at the back of the throat. There might be a few of these blisters, rashes, or sores, but often there have just been one.
Affected people might also go on to experience pain in the rectum and / or a sore throat. 

How is it transmitted?

Public health officials think that it’s spread by close personal contact rather than from sexual fluids (though that’s not certain yet). So any kind of sexual or intimate contact might put someone at risk of getting it, even if they are wearing a condom. 

Historically we know that monkeypox is not easily spread between people, but it can be spread by:

• Close skin contact with someone with an outbreak

• Sharing towels or bedding with someone with an outbreak

• Breathing in the droplets of someone with an outbreak. 

So, as you can see, most kinds of in-person sex involve these things.

The vast majority of people (95 percent) who have acquired monkeypox think they have got it from having sex. Where the symptoms occur suggests that it’s sexual activities such as oral and anal sex that might be the route for the virus to enter the body. Because the blisters and rashes can appear on the mouth, hands, legs, and the body, this means other forms of non-penetrative sex (kissing, handjobs, grinding, fucking between legs) may also carry some risk.

We don’t know if it’s contracted by sexual fluids (for example, jizz) but it’s seeming likely that it’s acquired by exposure to a blister, rash, or sore. There are some similarities between the signs of monkeypox and the signs of other STIs. The latest research suggests that some people getting monkeypox also got an STI too. 

What to do if you have monkeypox symptoms

If you have had any of these symptoms then it’s best to get in touch with a local sexual health service. In the UK you can call the NHS on 111, or you can call your doctor or local sexual health service. The general advice seems to be “call us first, don’t come in until we ask you to”. In the U.S. the CDC has information on monkeypox.

If you have mild symptoms you may be just advised to stay at home and self-isolate until you’re no longer infectious. This usually means waiting until any blisters have gone and healed, but it’s important to get advice from your doctor about that. For more serious symptoms you may be prescribed medicines to help relieve pain and in some cases this might require a hospital visit. You may also be offered a vaccine. 

In the UK all treatment is free and confidential. A key part of the UK’s response to this virus outbreak is to do what is known as ‘contact tracing’ where the staff at these clinics will try to get in touch with anyone that has had a close contact with someone who is infected. Like many other services in the UK, sexual health services have been heavily affected by budget cuts and reorganisations over the last 12 years. 

Safer sex

The safest thing to do is to avoid sexual (or close intimate contact) with people if you have any symptoms. It’s just good to try and chat with any sexual partners about whether you or they have had any of these symptoms lately, before having sex. 

Remember, this is still pretty uncommon but it’s just about being sensible. You could just send a simple text with a screenshot of the symptoms and say “hey, just to let you know, I’ve not had any of these lately, how about you?” 

If you’re in one of the social networks of people that are most affected by the virus then it’s even more important to do this. Even among sexually active gay and bi men, it’s still not super common but it’s wise to be watchful. If you are hosting events, you could ask people to not come if they have any symptoms of monkeypox. Just like we do if we suspect we might have Covid symptoms too. If you are offered a vaccine, it’s probably a good idea to accept it.

The kinds of things that might prevent STIs (like condoms and non-penetrative sex) might not be as effective for monkeypox, however they can’t hurt. We still don’t know enough yet about how it’s transmitted but these steps may offer some protection.

These are just the kinds of precautions we all could be taking all of the time too. Safer sex is not just about STIs, but all of the illnesses, and other harms, that we can be causing. So let’s just be sensible and communicate with each other. There’s more advice about how to talk about safer sex here.