Monkeypox: Symptoms, Treatment and Vaccines

Sameh Elgawly, MD, internal medicine physician, vice president, Inova Health System; Jorge A. Ramallo, MD, internal medicine and pediatrics physician, Inova Pride Clinic; Michelle Peninger, assistant vice president of infection prevention, Inova Health System.

Monkeypox is a rare viral disease caused by infection with the monkeypox virus. Although monkeypox isn’t a new disease, it hasn’t circulated widely in the United States before. Historically, monkeypox has been found in Central and West African countries, often in tropical regions.

Despite the current US monkeypox outbreak, the overall risk of contracting the disease or developing severe symptoms is relatively low. Still, it’s important to understand how the infection spreads and what you can do to stay healthy and safe.

How does monkeypox spread?

“The monkeypox virus primarily spreads through actual contact with a monkeypox lesion,” explains Michelle Peninger, assistant vice president of infection prevention for Inova Health System. “It’s not spreading through casual contact, and it’s not typically airborne.”

Direct contact with monkeypox can come from:

• An infectious rash
• Bodily fluids
• Clothing or linens that previously touched a monkeypox lesion or rash
• Scabs

Monkeypox may also spread through respiratory droplets during prolonged face-to-face contact. But Peninger emphasizes that prolonged contact is key — you don’t get monkeypox from short-term or passing contact, such as walking past someone in a grocery store.

Is monkeypox a sexually transmitted infection?

No, monkeypox isn’t a sexually transmitted infection (STI); however, close skin-to-skin contact with an infected person can spread the virus, so it can be transmitted through sexual activity.

“Intimate contact tends to be prolonged and higher risk by its very nature,” explains Dr. Sameh Elgawly, internal medicine physician, Inova Medical Group. “But that’s very different than saying that it’s a sexually transmitted infection. Intimate contact can include sexual contact, but that’s not the main way monkeypox is spreading.”

What are the symptoms of monkeypox?

The telltale symptom of monkeypox is a rash that may be blistered, itchy or painful. You may also have flu-like symptoms such as:

• Fatigue
• Fever or chills
• Headache
• Muscle or back pain
• Swollen lymph nodes

These symptoms typically appear within five to 21 days after contact with the virus. You’re contagious from the time your symptoms start until the rash has fully healed, which usually takes about two to four weeks.

Who is most at risk of getting monkeypox?

“To date, the LGBTQ+ population has been most affected by the monkeypox virus,” says Dr. Ramallo, internal medicine and pediatrics physician, Inova Pride Clinic. “The reason is just that the virus exists and has spread within those populations. But it’s important to understand that anyone can get monkeypox.”

People who have a higher risk of contracting monkeypox include:

• Anyone who has multiple sexual partners
• Healthcare workers who treat patients with monkeypox
• Men who have sex with men
• Sex workers
• Transgender people

Do I need to get tested for monkeypox?

If you have symptoms that could point to monkeypox, see your primary care provider. Your provider will evaluate your symptoms and risks to determine if you need to be tested.

“We’re not doing asymptomatic testing for monkeypox,” Dr. Elgawly notes. “But your provider can determine if testing is appropriate, based on your risk of exposure.”

Is there a monkeypox vaccine?

The United States Food and Drug Administration (FDA) has two vaccines for preventing monkeypox: JYNNEOS and ACAM2000. JYNNEOS is a two-dose vaccine and ACAM2000 is a single-dose vaccine.

Researchers are still studying the monkeypox vaccines, but current data shows they are about 85% effective in preventing monkeypox infection. You’re considered fully immunized two weeks after the second dose of JYNNEOS or four weeks after receiving the single dose of ACAM2000.

Who is eligible for the monkeypox vaccine?

The Centers for Disease Control and Prevention (CDC) recommends that people who have a higher risk of contracting monkeypox get the vaccine. This includes people who:

• Have a sexual partner who tested positive for monkeypox in the last 14 days 
• Have had multiple sexual partners in the last 14 days in a region where there’s known monkeypox infection
• Work in settings that increase exposure risk, such as in a laboratory that tests for or handles animals with orthopoxviruses, the family of viruses that monkeypox belongs to

“We may also use the vaccine as post-exposure prophylaxis,” notes Peninger. Post-exposure prophylaxis means you get the vaccine to minimize symptoms after a potential monkeypox exposure. “The best timeframe to give the vaccine is within four days of exposure, but it can be given up to 14 days afterward,” she adds.

How do I schedule an appointment for the monkeypox vaccine?

The best way to get the vaccine is to schedule an appointment through your local health department. You may also receive the vaccine if you’re a patient at the Inova Pride Clinic or at one of the clinics associated with the Inova Juniper Program.

Monkeypox treatment options

Most people who get monkeypox recover without treatment. But the antiviral medication TPOXX is available through emergency use authorization to provide treatment if you develop severe monkeypox symptoms.

“In general, if your symptoms are mild enough that you don’t need to go to the hospital, you probably won’t need TPOXX,” says Dr. Ramallo. However, he notes that you may be more likely to need TPOXX if you:

• Are immunocompromised
• Are pregnant or breastfeeding
• Have a chronic skin condition

If you experience significant symptoms, such as very painful lesions, contact your primary care provider. Your provider may offer you treatment options or extra guidance for at-home remedies.

How Inova is managing the global health emergency

“It’s almost serendipitous that the Inova Pride Clinic opened during Pride Month in June of this year,” shares Dr. Ramallo. The Inova Pride Clinic is a full-service primary care clinic tailored to the unique needs of the LGBTQ+ community. “When specific needs for marginalized groups arise, Inova has been able to meet those care needs and challenges. The Pride Clinic has been well-situated to serve as a key partner in combatting this pandemic.”

As Dr. Elgawly notes, responding to the COVID-19 pandemic has positioned Inova to proactively manage the monkeypox health emergency. “While monkeypox isn’t a new disease, it’s certainly novel to us in the United States. In a way, COVID primed us so that we’re prepared to think ahead.”

Inova is responding to the monkeypox health crisis by:

• Ensuring Inova clinics have enough vaccines and treatments to meet patient needs
• Equipping all Inova primary care clinics with testing capabilities
• Establishing referral patterns so that monkeypox-positive patients receive specialized care quickly
• Increasing care access for LGBTQ+ patients through the Inova Pride Clinic

If you have questions about monkeypox, contact your primary care provider. If you do not have a PCP, we welcome you to make an appointment with a provider at any of our Primary Care locations.