Answering your most common questions about monkeypox.

There have been 10,392 confirmed cases of monkeypox in the United States as of Aug. 10. This number is 4.5 times higher than the last time we spoke about it on Jul. 22.

AIDS United hosted a listening session for community-based organizations on Aug. 2 that was widely attended and many of you had questions about monkeypox that we were not able to get to. Let’s look at some of your frequently asked questions during the listening session.

What is monkeypox?

To be clear, monkeypox is not a sexually transmitted infection and is not related to chickenpox. The first human case of monkeypox was recorded in 1970 and was primarily linked to international travel to countries where the disease commonly occurs or through imported animals. Monkeypox is part of the same family of viruses that causes smallpox, variola virus.

Signs and symptoms

Those who have monkeypox will develop a rash that can initially look like pimples or blisters and will often be very painful or itchy. The rash can be located anywhere on the body but is often located on areas like hands, feet, chest, face, mouth, genitals or anus. Some people experience additional symptoms including fever, chills, swollen lymph nodes, exhaustion, muscle aches, headache or respiratory symptoms before or after the appearance of a rash.

How is monkeypox spread?

Monkeypox can be spread from person to person from the time symptoms start until the rash has fully healed, which is anywhere from two to four weeks. Symptoms typically start within three weeks of exposure to the virus.

The monkeypox virus is transmitted from person to person in ways such as:

  • Direct contact with unhealed rash, scabs or bodily fluids from a person with monkeypox.
  • Touching objects, fabrics (such as clothing or bedding), and surfaces that have been used by someone with monkeypox and have not been properly washed or disinfected.
  • A pregnant person with monkeypox can spread the virus to their fetus through the placenta.
  • Respiratory transmission during prolonged, face-to-face contact or during intimate physical contact (such as hugging, massage, and kissing).
  • Being scratched or bitten by an animal infected with monkeypox or by preparing or eating meat or using products from an infected animal.

It is still being researched by scientists if:

  • Monkeypox can be spread when someone has no symptoms.
  • How often monkeypox is spread through respiratory secretions and when someone with symptoms is more likely to spread the virus through respiratory secretions.
  • Whether monkeypox can be spread through semen, vaginal fluids, urine, or feces.

It is important to routinely clean and disinfect objects, surfaces and fabrics that have been in direct contact with a person infected with monkeypox using an EPA-registered disinfectant. Items or surfaces that have not been in contact with, or in the direct presence of the person with monkeypox do not need to be disinfected.

How is monkeypox being tested?

Testing can only be done once the monkeypox rash has appeared and can be done during any phase of the rash. Two swabs should be collected from each lesion (two to three lesions) for testing. In late June, the Department of Health and Human Services and Centers for Disease Control and prevention increased testing with five commercial labs: Aegis Science, Labcorp, Mayo Clinic Laboratories, Quest Diagnostics and Sonic Healthcare.

How is monkeypox being treated?

There are no Food and Drug Administration-approved treatments for monkeypox. However, tecovirimat is an antiviral medication approved to treat smallpox and cytomegalovirus which may be able to treat monkeypox. Human clinical trials show that the drug is safe and tolerable with only minor side effects and may shorten the durations of monkeypox.

Tecovirimat is the first-line treatment for monkeypox including treatment for those of us living with HIV.

What vaccines are available, and should I, as a person living with HIV, get vaccinated?

The FDA has issued an emergency use authorization that allows providers to use an alternative dosing regime of the JYNNEOS vaccine. This alternative dosing increases the amount of doses available by fivefold and allows individuals under 18 years of age who are high risk of monkeypox infection to receive the vaccine.

This authorization allows for a fraction of the JYNNEOS dose to be administered between the layers of the skin (intradermally) instead of a full dose beneath the skin (subcutaneously). Two doses of the vaccine given four weeks apart will still be needed.

The JYNNEOS vaccine is currently being distributed locally. You can find weekly jurisdictional vaccine distribution information here.

The JYNNEOS vaccine is highly preferred and safe for people with HIV. It was originally developed specifically for immunocompromised people in the event of a smallpox outbreak. The JYNNEOS vaccine is:

  • A series of two injections, four weeks apart (if you have received a smallpox vaccination in the past, you may only need one dose).
  • Considered fully vaccinated two weeks after your second shot.

The ACAM2000 vaccine should be avoided by people living with HIV, but is safe for others. ACAM2000 is:

  • A single shot.
  • Considered fully vaccinated 4 weeks after injection.

Are there concerns for those of us living with HIV?

It is currently unknown whether living with HIV affects someone’s risk for contracting monkeypox, although data indicates that someone with advanced or uncontrolled HIV may be at higher risk for severe or prolonged monkeypox following infection.

Prevention, diagnosis, and treatment of both HIV and monkeypox is expected to reduce the risk of severe infection.

How can we educate our community about monkeypox without furthering stigma?

It is important to communicate information about monkeypox and avoid increased stigma among populations by providing fact-based information. Voices early on from homophobic members of Congress has made it difficult to navigate messaging. Monkeypox is a public health emergency of international concern as well as a national public health emergency, and it is imperative that we communicate properly to the general public as well as at-risk populations.

Reducing stigma in our communications around monkeypox should look like:

  • Describe monkeypox as a legitimate public health issue that is relevant to all people.
  • Educate about prevention, how monkeypox spreads, symptoms, testing, and treatment available to minimize fear and promote action.
  • Use inclusive communication and frame information about health disparities using a health equity lens.

AIDS United, in partnership with Building Healthy Online Communities, will host a webinar about monkeypox for people living with HIV on Aug. 23. Registration now.