With the World Health Organization, and now the White House, declaring monkeypox a public health emergency, you may be feeling worried, especially after enduring the COVID-19 pandemic. Now what? Fortunately, monkeypox is no COVID-19 – not even close. So is a collective sigh of relief warranted? In many respects, yes. It can’t spread far through the air, so it’s less contagious in a public setting, and it’s rarely fatal. But it can be very painful, can last 2-4 weeks and can cause permanent scarring, so you should still try to avoid it. Here’s some information on how to navigate monkeypox.

What exactly is monkeypox?

Monkeypox is a virus. It is a disease that causes pox-like bumps on the skin (also referred to as a rash). Despite being named “monkeypox,” the source of the disease is likely rodents found in West and Central Africa. Before the current outbreak, cases were typically linked to international travel to Africa or humans coming in contact with an infected animal via bites, scratches or ingesting its meat. Cause for concern arose when several countries that do not normally report monkeypox (e.g., the U.S.) started to see an outbreak of the disease.  

How does it spread?

You can get monkeypox through direct contact with the rash, scabs, respiratory secretions or body fluids from a person with monkeypox. Direct contact can mean talking closely face-to-face for a prolonged time, kissing, snuggling, hugging, massaging and having sex. You can also contract it by touching objects and surfaces that someone with monkeypox used (like sheets and towels). Additionally, a pregnant person can spread the virus to the fetus.

Although the majority of monkeypox patients are men who have sex with men right now, anyone can contract it through close contact with someone who has the virus. And the window for infection is quite large: Monkeypox can be spread from the time symptoms start until the rash has completely healed, which can take up to four weeks. Symptoms usually start within 3 weeks of exposure to the virus.

What are the signs and symptoms?

At the very least, most people with monkeypox will get the telltale rash. The rash, which can look like pimples or blisters, may be painful or itchy. It can be located on or near the genitals, anus, hands, feet, chest, face or mouth. The rash will go through several stages (including scabs) before healing.

Other symptoms can include fever, headache, muscle aches and backache, swollen lymph nodes, chills, exhaustion, sore throat, nasal congestion and cough. The symptoms at the onset of the disease vary: Some report flu-like symptoms followed by a rash 1-4 days later. Others report getting a rash first, then other symptoms later. Some only experience a rash. So people with monkeypox can experience all or only a few symptoms.

What if I get it?

If you have symptoms of monkeypox, contact your healthcare provider. If they want to see you in person, to avoid infecting others, wear a mask and cover the rash with clothing. If you test positive, your provider will recommend next steps, such as any treatments, like creams, and how to avoid spreading the virus to others in your home (https://www.cdc.gov/poxvirus/monkeypox/specific-settings/home-disinfection.html).

Although your symptoms may be alarming, most people recover without the need for any drug treatments, such as investigational antivirals (https://www.cdc.gov/poxvirus/monkeypox/treatment.html) or vaccines (https://www.cdc.gov/poxvirus/monkeypox/vaccines.html ).

How do I protect myself and others?

If there’s any similarity between monkeypox and COVID-19, it’s in the steps we can take to prevent getting the virus. Handwashing and avoiding close physical contact with an infected person are the most important prevention measures. Monkeypox can be occasionally transmitted from infected surfaces, especially linens and towels. Remember, like COVID, anyone can get monkeypox, so stay informed.

Although the U.S. has not reported any deaths from monkeypox, it’s still important to follow the latest guidelines to protect yourself. Go to https://www.cdc.gov/poxvirus/monkeypox/index.html for more information.

For additional information about monkeypox from Huntington Health, go to: Monkeypox Information | Huntington Health

By Kimberly Shriner, MD, FACP

Medical Director, Infection Prevention and Control, Huntington Health

As if our past two and a half years of dealing with COVID was not enough, the director of W.H.O. has declared monkeypox a global health emergency.  In the last few weeks, this viral disease has spread around the world and is yet another example of the smallness of our planet and our vulnerability as a species. Monkeypox, which, like so many infectious diseases, is a zoonotic infection, harbored mostly in rodents (the name comes from a large outbreak in laboratory monkeys years ago) and in the same family as smallpox (variola). It has been endemic (and largely ignored by the rest of the world) in central and western Africa for many years. The familiar effects of globalization, international travel, environmental destruction, and climate change causing migration of wild animals to more hospitable ecosystems have contributed to the spread. 

Throughout history, infectious diseases create pandemics and prejudice.  When syphilis first emerged in Europe during the 15^th century it was called “the French disease” by England, Germany and Italy.  The French called it the “Neapolitan disease,” the Russians named it the “Polish disease,” the Polish, “the German Disease” and everyone else in the world blamed the “Europeans”.¹  In the end, like all infectious diseases, syphilis is a microbial pathogen that doesn’t care about the culture, gender, ethnicity, socioeconomic status, race, or sexual orientation of its host. It just wants to infect a nonimmune organism.

Unfortunately, like so many infectious diseases, monkeypox may also create stigma and isolation. As an infectious disease specialist whose career began in the late 1980’s, I have witnessed the consequences of ignorance, judgment, politicization and just plain meanness during the early days of the HIV pandemic. Infectious pathogens pose ongoing dangers to all of us, but it is not uncommon for them to be particularly damaging in marginalized and underserved communities.  This has nothing to do with the host and everything to do with limited access to care, cultural barriers, stigma, fear, and ignorance. If it were not for the grit, courage, and determination of “HIV activist groups” such as ACTUP and Shanti, the US government and the pharmaceutical industries may never have undertaken the research and policy development that has led to the virtual control, but not cure of AIDS around the world.  Tolerance and truth are not just important for societal growth, but they help control the spread of disease. Stigmatization and isolation can drive populations underground, not seek diagnosis and treatment and lead to further spread of the pathogen.

Although it can’t be said for all healthcare workers during those early and dark days of HIV, I never once saw hesitation among the Huntington Hospital staff to provide excellent and compassionate care for my patients. We all carry are own perceptions and opinions about the world around us.  So, let’s get this right from the beginning and going forward for all the future pandemics we face. We must stand up and show the importance of truth, equity, science, tolerance, and compassion in the face of emerging infectious diseases.

1. Tampa M et al. Brief History of Syphilis. J Med Life 2014 . March 15 . 7(1):4-10.

About Dr. Kimberly Shriner

Born and raised in Pasadena, Kimberly Shriner, MD, FACP, has been working to care for her community as an infectious disease specialist at ground zero in this pandemic. Dr. Shriner is also a tropical medicine specialist as well as the medical director if infection prevention and control at Huntington Health. She is Huntington’s leading physician regarding COVID-19 and has been an actively educating and informing the community throughout the pandemic.

Dr. Shriner efforts extend throughout the world. She was a pioneering specialist during the HIV/AIDs epidemic, and is the founder and director of Huntington’s Phil Simon Clinic providing complete HIV and infectious disease care for the underserved in the San Gabriel Valley. In 2001, she founded The Phil Simon Clinic Tanzania Project, a nonprofit, global outreach program in East Africa. The Project continues to be a platform for scholarship, post graduate training for Huntington’s staff and an amazing philanthropic experience for professionals in healthcare and supportive services.