What is monkeypox? Why are transgender people considered higher risk? How can you prevent monkeypox? With this new virus in the news and in our communities, it’s important to get the facts about monkeypox (hMPXV). Knowing how to protect yourself and how to get the monkeypox vaccine is vital to your health and safety. This blog includes what we know about monkeypox from a medical perspective.
Monkeypox (hMPXV or MPV) is an illness caused by monkeypox virus. The most characteristic finding of monkeypox is a rash that can appear on any part of the body. The rash can last for several weeks, usually presenting as small, flat dots on the body, and progressing to raised, often painful, lesions that will eventually crust over and resolve.
Commonly, MPV also causes flu-like symptoms (ie, fever, headache, fatigue, sore throat and/or body aches); these symptoms can appear either before or after the rash appears. It has made headlines due to recent outbreaks (that is, clusters of people getting and spreading monkeypox) occurring across Europe and the United States. In July of 2022, the World Health Organization (WHO) declared this monkeypox outbreak a public health emergency of international concern. Public health departments have identified queer and transgender people as higher-risk populations for getting this disease.
Monkeypox is related to smallpox, which also causes a sickness and rash but was eradicated in 1980. It is a viral zoonotic disease that occurs primarily in tropical rainforest areas of central and west Africa. Zoonotic diseases are a type of virus that is transmitted to humans from animals.
Human monkeypox is not a new disease. It was first identified in humans in 1970 and first identified in the United States in 2003. Recent outbreaks in American cities have brought new attention to this illness. Preventing the spread of monkeypox is important for individuals—and to protect our communities. While the news and spread may seem overwhelming, our public health departments have already taken steps that specifically support transgender and nonbinary folks.
Is monkeypox a sexually transmitted infection?
Monkeypox is transmitted through close contact with a person who has the disease and whose body has not fully recovered. Monkeypox is not a sexually transmitted infection (STI), but having sex with someone who is positive for monkeypox will expose you to the disease.
Monkeypox is spread between humans by close contact. Most commonly, this is through direct skin to skin contact with someone who has the infection, or through sex or intimate activity with someone who has MPV (i.e., kissing and/or oral, anal, or vaginal sex). It’s also become clear that some people have gotten infected by touching unwashed bed sheets and linens that contain MPV. Coughs, sneezes, respiratory secretions, and skin lesions of an infected person can all transmit monkeypox. Prolonged face-to-face contact, such as conversations, sex or intimacy, shared space at concerts and shows, or other close contact also increases the risk. Health workers, people who live in the same household, and other close contacts of active cases are at greater risk. The Centers for Disease Control (CDC) assigns different levels of risk transmission based on the type of exposure someone has had.
The symptoms of monkeypox generally last two to four weeks. The infection will resolve on its own, but the symptoms (especially the pain from lesions) can be severe. It is very unlikely that someone would have monkeypox and not know it. The time period from exposure to first symptoms is usually from 6 to 13 days but can range from 5 to 21 days. This is why it is important to protect yourself from the disease, especially if you are not yet vaccinated against monkeypox.
While clinical presentation can vary, World Health Organization outlines a typical timeline of monkeypox infection:
Commonly, people experience systemic symptoms, such as fever, intense headache, back pain, muscle aches, and intense fatigue. These symptoms last from 1-5 days and can appear either before or after the rash develops. Lymphadenopathy (swollen lymph nodes) is also a distinctive feature of monkeypox.
A skin eruption or rash is most characteristic of MPV. This usually begins between 1-2 days before and 3-4 day after onset of any systemic symptoms. This rash is usually painful and tends to begin at the site of infection (such as the mouth or anogenital region) and then spread to other body parts (such as the face and trunk). It evolves sequentially from macules (lesions with a flat base) to papules (slightly raised firm lesions), vesicles (lesions filled with clear fluid), pustules (lesions filled with yellowish fluid), and crusts which dry up and fall off. Usually, people will have lesions in these different forms at the same time. Not everyone has the same severity of eruptions. Some people may have only a few, while others may have over a hundred or even several thousand.
Other common symptoms include pain at the site of infection – specifically proctitis (inflammation of the rectum) and pharyngitis or tonsillitis (inflammation of the throat or tonsils). MPV proctitis can present as severe pain, bleeding, discharge, or tenesmus (a feeling like you need to have a bowel movement even though you don’t). Most of the more serious complications of this 2022 MPV strain are due to the rash (where open sores can get superimposed bacterial infections), pain from the lesions, and challenges with eating and drinking because of throat pain. Complications are more likely in someone that is severely immunocompromised.
These eruptions can transmit the disease to other people. Unhealed lesions that still have a scab or crust are still contagious. According to WHO, in 95 percent of cases, monkeypox affects the face. In 75 percent of cases, people get lesions on the palms of their hands and soles of their feet. Also affected are oral mucous membranes (in 70 percent of cases), genitalia (30 percent of cases), and eyelids (20 percent of cases), as well as the cornea.
Are trans people more likely to catch monkeypox?
Transgender and nonbinary people are not necessarily at higher risk. Certain behaviors which expose someone to the disease—for example, hooking up with someone who has monkeypox, or going to an event where you have close contact with multiple people—would increase your risk. Your gender identity does not predict whether you will get monkeypox. Like any disease, monkeypox can affect anybody who is exposed. Cisgender people, children, and heterosexual people can all get monkeypox.
If you are concerned about being exposed, or if you think you may have monkeypox, call your county health department or your healthcare provider. Most often, MPV isn’t an emergency, so it’s best not to visit a clinic or emergency room unless told to do so (or if it’s truly an emergency!). When you call, you will be asked your name and birth date, as well as the following information:
- Date of onset of fever
- Date of onset of rash
- Current status or stage or your rash
There are ways that a healthcare provider can test for MPV. Usually, this is by collecting a swab that is brushed across an open lesion. This gets sent to a lab and results come back within days. Until then, it’s important to keep lesions covered and to avoid close skin to skin contact with others. Working with public health will help you recover from monkeypox and limit the spread of the disease in your community.
Is there treatment for monkeypox?
Most of the time, no specific treatment for MPV is needed and the lesions will resolve on their own. Rarely (and usually only in severe cases), hospitals and medical providers can make a special request for treatment with an antiviral medication called Tecovirimat (TPOXX). This is not routinely used, but you can learn more about that medicine here.
If you have symptoms, you should definitely reach out to a medical provider. They can help provide guidance around managing your symptoms and preventing additional spread. The CDC recommends staying isolated while you still have active lesions on your body. This can be tough to do, but you can learn more about the recommended guidelines here.
Can I get a vaccine to prevent monkeypox?
There are two vaccines to prevent monkeypox: MVA (which is called JYNNEOS in the United States) and ACAM2000. The MVA vaccine JYNNEOS is used most commonly because it has fewer side effects.
Anyone can get monkeypox, but men who have sex with men are the first socially-connected group that has been affected in this particular outbreak. Most, but not all, of the cases currently in the U.S. have been among men who have sex with men.
Because of this, our community has been prioritized by many public health groups. For example, in many cities, it is now possible to get the monkeypox vaccine if you:
- Were exposed to someone with possible or confirmed monkeypox in the last 14 days
- Are engaged in sex work or other forms of transactional sex where skin-to-skin contact occurs
- Are a cisgender man, transgender man, transgender woman, or nonbinary person who has sex with men
- Have had more than one sex partner in the last two weeks in an area experiencing high transmission
- Are taking or are eligible to take HIV pre-exposure prophylaxis (PrEP)
- Are living with HIV
- Have been diagnosed with a sexually transmitted infection (STI) in the last three months
If you fall into any of these categories, contact your public health department to see if you are eligible for vaccination. The vaccine given to prevent monkeypox is a two-phase vaccine, with two shots given 4-12 weeks apart. Some people get a “blep” or subcutaneous injection that makes a small bubble under their skin. Others get an intramuscular injection. Either way, a single dose gives good protection against the disease. Because data on vaccine efficacy in this outbreak is still pending, the best prevention is getting vaccinated and taking precautions as well. People can get a vaccine after they have already been exposed to try and prevent illness.
There are other things you can do to prevent infection while you are waiting for your first or second vaccine dose. This resource from Multnomah County offers a comprehensive list of steps that can protect you and your loved ones from getting sick. Here are some ways that are recommended to reduce your risk of catching monkeypox:
- Have sex in a well-lit place where you can see if someone has a rash on the part of their body that will be in contact with yours.
- Talk openly about whether they have felt sick or noticed new bumps or a rash recently. This is not a “sexy” conversation, for sure, but until we get a lot more vaccines available, this is a way to stop transmission.
- Consider taking a break from back room sex and sex club sex until more folks are vaccinated and the virus is no longer spreading locally.
- Consider “keeping your shirt on” at clubs. So far, most of the cases seem to be from direct sexual contact, but we are still learning, and we know that direct skin-to-skin contact with the rash or bumps can spread disease.
- Don’t share towels or clothes at the gym, beach, etc.
- Sometimes an individual with infection only has sores on their penis or in their rectum/vagina. In those cases, using condoms may reduce risk of transmission. The best prevention is to avoid intimate/sexual contact until the sores are completely gone or they’ve been examined and tested by a medical professional (and any test results negative).
- Keep up-to-date contact information for partners so you can reach them if you test positive for hMPXV. They may be able to get a preventive vaccine.
Follow your public health department, local LGBTQ health services or clubs, and other resources in your community. Many towns have pop-up vaccine clinics that offer no-waiting or no-appointment options. More vaccine will be available as
Monkeypox (hMPXV) can feel scary and overwhelming, but taking precautions will help you stay healthy. If you aren’t sure where to start, reach out to our Care Team to find monkeypox resources in your area.
