Monkeypox

What is monkeypox?

Monkeypox is a previously rare illness caused by infection with the monkeypox virus. The monkeypox virus is a member of the family of viruses that includes variola, which causes smallpox. Monkeypox symptoms are similar to smallpox, but milder and rarely fatal.

The first human case of monkeypox was recorded in 1970. Prior to the current worldwide outbreak, monkeypox had been reported in people in several central and western African countries. Previously, almost all monkeypox cases in people outside of Africa were linked to international travel to countries where the disease most commonly occurred or through imported animals. These cases occurred on multiple continents. In 2022, cases started occurring in large numbers outside of Africa, first in Europe and then in the U.S. and dozens of other countries around the globe. The New York City area has been the part of the U.S. most impacted by the monkeypox outbreak, but cases are occurring across the country.

As cases rise in in the New York metropolitan area during the current monkeypox outbreak, Montefiore Einstein’s outpatient Oval Center and Center for Positive Living/Infectious Diseases Clinic sites, directed by Barry S. Zingman, MD, are major sites for evaluation, testing, treatment and vaccination.

Please call one of our locations below to make an appointment:

The Oval Center at Montefiore
3230 Bainbridge Avenue
718-920-6769 (evaluation and treatment of possible/known monkeypox only)
Monday-Thursday 9:00 AM-5:00 PM; Friday 9:00 AM-1:00 PM

Center for Positive Living / Infectious Diseases Clinic
3444 Kossuth Avenue, 3rd Floor
718-920-6769 (evaluation and treatment of possible/known monkeypox only)
Monday-Wednesday 8:40 AM-5:00 PM; Thursday 8:40 AM-7:00 PM; Friday 9:00 AM-1:00 PM

Read on to learn how to recognize and prevent monkeypox, how to protect yourself and others from infection, available treatment, and other answers to other frequently asked questions.

What are the signs and symptoms?

People with monkeypox get a rash that may be located on or near the genitals or anus and could be on other areas like the hands, feet, chest, face, or mouth. It can initially look like bumps, ulcers, pimples or blisters and may be painful or itchy. The rash will evolve through these stages over time, eventually scabbing over before healing with new skin.

Other symptoms of monkeypox can include:

  • Fever
  • Chills
  • Swollen lymph nodes
  • Fatigue
  • Muscle aches and backache
  • Headache
  • Respiratory symptoms (e.g. sore throat, nasal congestion, or cough)

You may experience all or only a few of these symptoms. The fever, chills and other symptoms can occur before the rash in some people, but in others it may follow the rash or never occur at all.

Can anyone get monkeypox and how does it spread?

Anyone can get monkeypox infection. In the current outbreak so far, certain groups are being affected more than others, including gay or bisexual men who have sex with men (MSM) and their close contacts, but cases have also been diagnosed in other adults, children, and college students. Everyone is at risk and needs to be aware of monkeypox infection.

Monkeypox predominantly spreads through close, personal, skin-to-skin or sexual contact, including:

  • Direct contact with rash, scabs or body fluids from a person with monkeypox.
  • Touching objects (including cups, eating utensils, toothbrushes, and others), fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox.
  • Contact with respiratory secretions of someone with monkeypox.

Monkeypox can be spread from the time symptoms start until the rash has healed, all scabs have fallen off, and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks.

How can I protect myself against monkeypox?

The best way to protect yourself from monkeypox is to avoid sex and other unprotected close contact with someone who has or may have monkeypox and unprotected contact with their body fluids and things they’ve touched. Limiting new, multiple or anonymous sex partners will help to lessen the chance of contracting monkeypox.

People can minimize their risk for exposure by:

  • Asking sex partners if they have a rash, mouth ulcers or other symptoms of monkeypox or have had sex with someone with these symptoms or the illness
  • Using male condoms properly and throughout sexual activity.
  • Avoiding skin-to-skin contact with someone who has a rash or other monkeypox symptoms and those diagnosed with monkeypox.
  • Not sharing bedding, towels, clothing, utensils, or cups with a person with monkeypox. If you must handle these items, wear personal protective equipment (PPE) including a medical mask and disposable medical gloves, and disinfect your hands and other exposed skin with soap and water or an alcohol-based hand sanitizer.

What should I do if I have been exposed or have monkeypox symptoms?

If you have any symptoms of monkeypox, talk to your healthcare provider or go to a local clinic or emergency department for evaluation and testing, even if you don’t think you had contact with someone who has monkeypox. Minimize close contact and sharing of potentially contaminated items with others until the evaluation is complete and your medical provider gives you further instructions.

If you have been exposed, but don’t have any symptoms, you should seek vaccination because early vaccination (especially within 4 days of exposure) can help prevent the development of monkeypox.

What should I do if I have been diagnosed with monkeypox?

It is important to follow your medical provider’s instructions. If you have an active rash or other symptoms, stay in a separate room or area away from people or pets you live with, when possible. If you are sharing an apartment or house with others, wear gloves. If you can, wash your own bedding and clothing separate from other people’s. If someone else is washing bedding and linens, they should wear gloves and a medical mask.

Anyone who is living with or caring for you should wear personal protective equipment including gloves when they come into contact with you. They should also get vaccinated against monkeypox.

People with monkeypox are advised to abstain from sex for up to 8 weeks to avoid passing the virus to others through contact with body fluids. Research is in progress to better understand how long people should avoid sex for after the illness, so speak to your medical provider about the latest recommendations.

Is there treatment available for monkeypox?

Most people diagnosed with monkeypox have a mild illness that improves with symptomatic care only, as needed. This care includes:

  • keeping lesions clean and dry to avoid them getting infected
  • Pain and fever control (over-the-counter acetaminophen or anti-inflammatory medicines; prescription pain medications if needed)
  • stool softeners
  • soothing or numbing gels applied to painful areas in the mouth, in or around the rectum, and on the genitals
  • if necessary, treatment of skin infection with topical or oral antibiotics

In addition, antiviral therapy is prescribed for people with particularly symptomatic, severe or potentially scarring lesions in sensitive spots on the body, and for people with weakened immune systems who are at risk for severe illness. The main treatment for monkeypox (tecovirimat; Tpoxx) is usually given in pill form for two weeks. It can be given intravenously in the hospital if you can’t take pills. Your doctor will determine if your case should be treated with tecovirimat.

Some patients with monkeypox may require further treatment and evaluation for admission to the hospital if they develop severe pain, infected lesions that do not improve with local or oral therapy, an inability to eat or dehydration due to pain or nausea or vomiting, severe constipation, difficulty urinating, or concerning organ infection such as illness of the brain, lungs, heart or liver. Complications like these will require therapies aimed at these conditions and are often reasons for antiviral therapy.

Can I get vaccinated?

Monkeypox vaccination is not necessary for most people. The CDC recommends vaccination for people who have been exposed to monkeypox and people who may be more likely to get monkeypox.

People more likely to get monkeypox include:

  • People who have been identified by public health officials as a contact of someone with monkeypox
  • People who are aware that one of their sexual partners in the past 2 weeks has been diagnosed with monkeypox
  • People who had multiple sexual partners in the past 2 weeks in an area with known monkeypox
  • People whose jobs may expose them to monkeypox or similar viruses, such as:
    • Laboratory workers who perform testing for these viruses
    • Laboratory workers who handle cultures or animals with these viruses
    • Some designated healthcare or public health workers

At the current time, vaccine supplies are very limited. Therefore, vaccination is only available for eligible people through local departments of health, including the NYC Department of Health and Mental Hygiene, and some other select locations. Montefiore Einstein is working with state and local governments as vaccines become more available and will provide updates if supply levels or access change.