How do you contract monkeypox (mpox)?

Reviewed by Dr Sameer Sanghvi

Mpox (previously known as monkeypox) is a fairly rare disease that was first identified by scientists in 1958. It was first found in monkeys being kept for research, but despite its name it’s actually thought to come from rodents like rats or mice.

It mainly affects areas of central and western Africa, and up until 2022 there had been just a handful of cases recorded outside of this region. But in spring of 2022, a number of cases of mpox were identified across the UK, Europe and the US. 

Mpox is usually mild, the ‘West African clade’ (the strain identified in the UK in 2022) is thought to be less severe than others and carries around a 1% risk of dying. Most people will recover within two to four weeks, but it’s contagious so you’ll need to isolate while you have mpox. 

It’s important you seek medical help if you think you have mpox, as you might have to stay in a specialist hospital to make sure you get the right treatment and to avoid spreading the disease to anyone else. 

In this article we’re going to look in more detail at how mpox can be spread, ways to prevent catching mpox and how sometimes mpox might be mistaken for a sexually transmitted infection (STI). 

What is monkeypox? 

Monkeypox or mpox is an illness caused by the mpox virus, this is a type of orthopoxvirus and is quite similar to the virus that causes smallpox (the variola virus). It causes a variety of flu-like symptoms including a fever, aches and pains, swollen glands, shivers and tiredness. But perhaps the most distinctive symptom is the rash that mpox causes. 

The mpox rash usually starts as raised spots which then turn to blisters filled with fluid. These blisters will scab over and fall off. 

How is monkeypox (mpox) transmitted?

Mpox can be contracted a few different ways. The main ways you can catch mpox are:

• Being bitten by an infected animal 
• Touching body fluids, spot, blisters or scabs of an infected animal 
• Eating uncooked/not properly cooked meat from an infected animal 
• Touching other products (fur or hides) from an infected animal 
• Touching the blisters or scabs of a person with mpox  
• Touching clothing, bedding or towels used by someone with mpox 
• The coughs or sneezes of someone with a mpox rash

The person/animal infected is considered contagious up until the scabs falling off. But those scabs can still contain some infectious virus material when they fall off.

It’s important to remember that animals are only likely to be infected with the mpox virus in parts of central and western Africa. So, if you’re bitten by an animal in the UK, while you should always get this checked out by a clinician, you’re extremely unlikely to catch mpox that way.

In fact, despite a number of mpox cases in the UK in spring 2022, you’re still extremely unlikely to catch mpox here, unless you’ve: 

• Travelled to central or western Africa 
• Been in close contact with someone who has monkeypox

What does mpox look like? 

The mpox rash can sometimes be confused for other illnesses. It can initially be confused with chickenpox as the rash can be very similar, and there have been anecdotal reports of people confusing it with things like genital warts.

The rash itself goes through different stages, known as ‘skin eruption stages’. This usually starts off as a red flat rash, which then gets bumpy. Once the rash is bumpy, the blistering starts, often the blisters are filled with liquid. The blisters then scab over and fall off. This process can take up to three weeks.

The rash isn’t usually the first symptom, this can follow between one and five days after the flu-like symptoms and swollen lymph nodes (glands). So, if you notice swelling either side of your neck, under the chin, armpits or around the groin, this is another visual mpox symptoms to look out for. 

Is mpox a sexually transmitted infection? 

There’s been lots of reports in the press of mpox being spread through sexual contact, which is true, but mpox isn’t an STI.

As discussed mpox is an infection spread through close contact either with an infected animal or person with the virus. So, if you have sexual contact with someone with the virus, there is a chance you will catch it. 

The mpox outbreak that started in spring 2022 in the UK was also largely circulating in gay and bisexual men, or men who have sex with men (MSM). MSM tend to be more at risk of certain STIs, which might contribute to the misconception of mypox being an STI. But mpox can be spread through close contact with anyone who has the virus, and it’s not exclusive to certain groups of people.  

Could mpox be mistaken for an STI? 

If you have mpox and the rash is in the genital area, there is a chance you could mistake it for an STI. In fact, some of the early cases of monkeypox (s it was called at the time) in the UK in 2022 had attended sexual health clinics for testing. And it wasn’t until the UKHSA released photos of the mpox rash after the first cases were confirmed, that sexual health clinicians realised that some of their patients could have the virus.

Mpox and warts 

Some people might mistake the initial mpox bumpy rash for an STI like genital warts, if it’s in the genital area. However, the two do look quite different. As mentioned, mypox starts as a red flat rash, which then gets bumpy and blistered.

Genital warts are small fleshy bumps or nodules that slowly grow and then spread. If you think you might have genital warts you should go to a sexual health clinic, your GP or you can use a service like our photo upload service, and one of our clinicians will assess your images. 

You can find out more about genital warts and treatment here. 

Can condoms protect you from mpox? 

As mpox isn’t an STI, as is just spread through close contact, condoms are unlikely to protect you against it. But condoms are still one of the best ways to protect against STIs, especially when you’re having sex with someone new, someone who’s STI status you don’t know, or you/your partner(s) are having sex with other people.  

How do you test for mpox?

Testing for mpox can be quite tricky, as it can sometimes be confused with other illnesses. If a clinician thinks you have mpox they will organise a PCR test to swab your blisters or scrape a scab. This swab will then be sent to a specialist lab for testing. 

If you test positive for mpox you and any close contacts will have to isolate for up to 21 days. 

How to prevent catching mpox 

We already know that catching mypox in the UK is extremely rare, but there are some steps you can take to contracting it:

• Washing your hands regularly with soap and water or using hand sanitiser 
• Avoid uncooked meat/wild animal meat (if it’s come from at-risk areas) 
• Avoid stray/wild animals in at-risk area 
• Avoid sharing clothing, bedding or towels with anyone who has mpox 
• Avoid close contact with people who have mpox 

Where to go if you think you have mpox 

If you think you might have mpox, it’s really important you speak to a medical professional. Call your GP or 111 and they will advise you on isolation, testing, whether you need to come into hospital and treatment. You should stay at home and avoid contact with anyone until you’ve been told what to do. 

For the most up to date information on mpox head the NHS or government websites. 

References 

https://www.nhs.uk/conditions/monkeypox/
https://www.gov.uk/guidance/monkeypox
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00228-6/fulltext
https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates
https://www.gov.uk/guidance/monkeypox-diagnostic-testing
https://www.dean.st/health-amp-wellbeing/monkeypox-alert-2022-ukhsa/
https://www.aidsmap.com/news/may-2022/monkeypox-spreading-among-gay-men-worldwide
https://www.theguardian.com/world/2022/may/25/monkeypox-may-have-been-circulating-in-uk-for-years-scientists-say