Sex, ‘casual contact’ and pimples:
A guide to separating monkeypox facts from fiction
LOS ANGELES — With local, state and national officials declaring emergencies over the monkeypox outbreak and a scramble for vaccines spurring long lines — and waits — in many U.S. cities, the latest updates about the rare virus can seem overwhelming and, well, confusing.
But experts say it’s important to remember that monkeypox is a known disease that is rarely deadly (unlike the coronavirus) and already has an approved vaccine and treatment.
That’s not to say there aren’t real concerns about the outbreak, including a vaccine shortage, rapidly rising infections and the fact that one community — men who have sex with men — remains most at-risk.
The first step in addressing this virus is education, experts say, so people can better understand their risks and know how the disease spreads and how to prevent transmission.
CAN ONLY GAY OR BISEXUAL MEN GET MONKEYPOX?
No. While the outbreak is spreading primarily among gay and bisexual men, as well as some transgender and nonbinary people, anyone — regardless of gender or sexual orientation — can become infected.
“No single individual or community is to blame for the spread of any virus,” said Dr. Tomás Aragón, California’s public health director. “Monkeypox can affect anyone, and it spreads by skin-toskin contact, as well as from sharing items like clothing, bedding and towels.”
Dr. Stuart Burstin, the interim national director of infectious diseases for the AIDS Healthcare Foundation, said it was “by chance” that monkeypox first infected men who have sex with men. The virus has continued to spread in that group, as transmission can easily occur during sexual encounters.
Of the more than 400 confirmed and suspected monkeypox cases in Los Angeles County, 99% have been in men, about 90% of whom identified as LGBTQ, according to data from the Department of Public Health. Similar demographics from state and national health officials have found the same trend, and for that reason, gay and bisexual men, as well as some other queer people, remain most at risk.
“The risk to the general public is low, but there is a chance — and I would predict — this virus does make some inroads into the general public,” Burstin said. In very rare instances it already has: At least five children in the U.S. and one pregnant woman have been infected, according to health officials.
HOW DOES MONKEYPOX SPREAD?
Monkeypox spreads primarily through close skinto-skin contact, but it also
can be passed through infected bed sheets or towels or through “respiratory secretions,” according to the Centers for Disease Control and Prevention.
Intimate contact has to include direct, and usually prolonged, interaction with an infected sore, rash or lesion, but Burstin said such markings may not always be obvious, especially at the beginning of an infection.
“It is possible that someone can have early disease that looks like a pimple or something in the anus you can’t see,” Burstin said.
There’s no evidence that monkeypox can spread through shared airspace, like the coronavirus, experts say.
“I think it’s really important for people to recognize monkeypox is not like COVID,” Aragón said. “(Monkeypox) is very different in terms of transmission; you really have to have a close, physical contact.”
WHAT ARE THE TYPICAL SYMPTOMS?
Dr. Leo Moore, director of clinical services for the Los Angeles County Department of Public Health, said that people with monkeypox typically develop a flu-like illness, including fever, fatigue, muscle aches and enlarged lymph nodes. Those symptoms are then followed by a rash.
“In many instances with the current outbreak, people are developing a rash with or without swollen lymph nodes that can occur in the genital region or anally as well,” Moore said. “We’re also seeing the rash occur all over the body, including in the face.”
He said people usually develop symptoms a week or two after being exposed, but it can take up to 21 days for evidence of the virus and symptoms can last up to four weeks.
“The rash doesn’t look exactly the same on every person,” L.A. County Director of Public Health Barbara Ferrer said. That’s why it’s important to check yourself and get tested if anything looks irregular, she said.
Symptoms are usually mild, although lesions can become quite painful for some patients, Moore said. No one has died of monkeypox in California, but at least 14 people have been hospitalized for the illness.
WHO CAN GET A VACCINE OR TREATMENT?
approved by the Food and Drug Administration for monkeypox, can be used preventatively and within two weeks of an exposure. But doses are currently limited, which has prompted health officials to set eligibility requirements so those at greatest risk of infection can get the first available shots.
In Los Angeles County, officials recently expanded eligibility, but the focus is still only on those who have been directly exposed or gay and bisexual men and transgender people who meet certain criteria, such as having multiple recent sex partners.
As for treatment, health experts say most patients can recover on their own, but there is one antiviral — tecovirimat, also known as Tpoxx — that can be administered to help ease symptoms. However, many health providers have had difficulty accessing Tpoxx, which is recommended only for use in severe cases or for people with certain high-risk health factors. CDC officials have said they are working to streamline the process so more people can get access to the drug.
As of this week, the California Public Health Department said 1,144 courses of TPOXX have been delivered and are ready for use at 71 sites around the state.
CAN MONKEYPOX SPREAD ASYMPTOMATICALLY?
“It does not, at this point, look like there’s risk from asymptomatic spread,” said Dr. Jay Gladstein, the chief medical officer for APLA Health, an L.A. group focused on providing healthcare to the LGBTQ community.
While this outbreak continues to be studied, Gladstein said transmission has so far been linked only to contact with virus-filled lesions.
But people should know the virus can be spread until lesions have healed completely and are covered by a new layer of skin, which can take weeks.
ARE MASSAGE THERAPISTS OR TATTOO ARTISTS ARE RISK?
Burstin said the risk remains very low for people who work in industries that come in contact with skin, but he said it’s important to monitor for rashes or bumps.
“The safety is really very high,” Burstin said. “If you don’t see a lesion, the person is much more likely than not to not be infectious.”
He said to be extra safe, professionals should wear gloves and increase cleaning protocols, but he didn’t recommend drastically changing operations.
“The skin lesions are visible, and for the people who have them, they’re painful, so hopefully people will notice,” Gladstein said. He said there have not been any outbreaks among healthcare workers who provide care to patients with active monkeypox.
The two-dose Jynneos vaccine series, which has been