The most important info on Mpox ("monkeypox")

• Regarding Mpox ("monkeypox"), there is reason to pay attention: The viral infection is currently spreading mainly in sexual networks of men who have sex with men.
• Although the disease usually heals on its own, it can be extremely painful.
• Symptoms may appear as early as the day after infection. Most often they begin within 5 to 11 days, but it can take up to three weeks (incubation period).
• Typical are sometimes very painful skin changes - from rashes/blemishes to nodules and blisters to pustules, sores and scabs.
• The skin changes often begin on the face, in the genital or anal region.
• The "pox" usually heal on their own after two to four weeks, but can leave scars.
• These skin lesions are often preceded or accompanied by general symptoms such as fever, headache, muscle or back pain or swollen lymph nodes.
• The main route of transmission is close, prolonged skin-to-skin contact, for example during cuddling or sex - especially contact with the skin lesions or scabs.
• The fluid in the blisters and from the sores that appear after the blisters burst is particularly contagious, as is the scab that forms over them.
• The virus can also be transmitted through objects used during sex (e.g. sex toys) or through contact with contaminated textiles (e.g. clothing, bed linen, towels).
• In the case of particularly painful courses, pain treatment in hospital may be necessary. It is also important to prevent bacterial superinfections of the wounds.
• For people with severe courses, a therapy with Tecovirimat has been approved since January 2022.

In the following, we have compiled important questions and answers about "monkeypox".

What is "monkeypox"?

The "monkeypox virus" (Monkeypox Virus or Mpox-Viren) was first identified in monkeys. However, it is thought that the viruses are actually found mainly in rodents (e.g. squirrels and rats). Transmission to humans is possible, for example, through bites, body fluids and consumption.

The viruses cause sometimes very painful skin changes (from rashes to nodules/blisters to pustules and sores that are scabbed over). They usually heal on their own, but can leave scars.

From person to person, "monkeypox viruses" are transmitted mainly through close and prolonged skin-to-skin contact, especially through contact with the skin lesions (rash, vesicles, pustules, sores, scabs).

In the current outbreak, Mpox ("monkeypox") spreads mainly in sexual networks of men who have sex with men. The main ports of entry into the body are the mucous membranes involved in sex (anal region, penis, oral cavity).

How dangerous is "monkeypox" (Mpox)?

Although the disease usually heals on its own, it can be extremely painful, especially if the skin damage occurs in the anal or genital area. The pain can be so severe that treatment is only possible in hospital.

Bacterial infections that "sit on top of the damaged areas" are also possible.
The recommended or ordered isolation, which lasts at least 21 days, is also experienced as stressful.
For the general population, the RKI currently estimates the health risk as low.

How dangerous is "monkeypox" for people with HIV?

So far, HIV-positive people with functioning therapy and a good immune status do not seem to be at greater risk than others.

People with a severely weakened immune system could be at a higher risk of infection and a higher risk of a more severe course. However, there are no reliable data on this so far.  

People with HIV can also be vaccinated as long as their helper count is at least 100.

However, it has been observed that the vaccination effect can be lower in people with a weaker or weakened immune system (100 to 750 helper cells per microlitre of blood plasma).

How is "monkeypox" transmitted?

The main transmission route for Mpox viruses ("monkeypox viruses") is considered to be close and prolonged skin-to-skin contact (e.g. during cuddling or sex), especially contact with the skin lesions (rash, blisters, pustules, sores, scabs).

The fluid in the blisters and from the sores that appear after the blisters burst is particularly contagious, as is the scab that forms over them.

The virus can also be transmitted through objects used during sex (e.g. sex toys) or through contact with textiles (for example, clothing, bed linen, towels) to which scab residues containing Mpox viruses adhere.

In the current outbreak, the main ports of entry for the virus into the body are the mucous membranes involved in sex (anal region, penis, oral cavity).

Detailed information: Monkeypox transmission

What are the symptoms of monkeypox?

Symptoms may appear as early as the day after infection. Most often they begin within 5 to 11 days, but it can take up to three weeks (incubation period).

Typical symptoms are sometimes very painful skin changes - from rashes/blemishes to nodules and blisters to pustules, sores and scabs.

The skin changes often start on the face, in the genital or anal region. The pain they cause can be so severe that they have to be treated in hospital.

Bacterial superinfections are also possible, i.e. inflammation of the damaged areas.
The "pox" usually heals on its own after two to four weeks, but can leave scars.

Often the skin changes are introduced or accompanied by general symptoms such as fever, headache, muscle or back pain or swollen lymph nodes.

Vaccination against smallpox was compulsory until 1976 in the FRG and until 1982 in the GDR. Many people born up to this time have this typical smallpox vaccination scar on their upper arm. )

Is there a vaccination against Mpox ("monkeypox")?

The smallpox vaccine Imvanex is licensed in Europe for people aged 18 and over. According to the STIKO recommendation, it can also be used to protect against Mpox ("monkeypox").

A distinction must be made between two different occasions for vaccination against Mpox:

• the subsequent vaccination (post-exposure prophylaxis, after one has been "exposed" to the pathogen = after an exposure).
• preventive vaccination.

Since the vaccine is scarce for the time being, the STIKO recommends giving priority to post-exposure vaccination. It is especially recommended after close physical contact via skin or mucous membranes with a person infected with Mpox (e.g. contact during sex). Preventive vaccinations are already given, but there are often waiting lists. People with immunodeficiency are vaccinated first.

The vaccine is usually well tolerated; vaccination reactions such as

• pain, redness, swelling and itching at the injection site
• muscle aches, headache, fatigue and nausea are common

are common (in more than one in ten cases), but usually subside after a few days. We have compiled all the important information on monkeypox vaccination on this page.

How else can you protect yourself from Mpox ("monkeypox")?

In addition to vaccination, the most important measures to reduce the risk of transmission are:

• Pay attention to skin changes on yourself and others and avoid skin and mucous membrane contact with them (rashes, blisters, sores, scabs) if possible.
• Do not share objects (e.g. dildos and other sex toys) during sex.

In the case of sexual transmission, the pathogens at the entry sites (especially mouth, penis/genital region, anal region) often lead to very painful symptoms. Condoms reduce the risk.

The "monkeypox" risk is further reduced by avoiding contact with objects and textiles that have been in contact with skin lesions of infected persons for a longer period of time. Mpox-virus ("monkeypox virus") can remain contagious outside the body for a long time.

What to do if you suspect "monkeypox"?

Image of different monkeypox pustules (Photo: UKHSA)

Unusual skin changes should be clarified by a doctor (by a general practitioner, dermatologist, an HIV specialist practice, a checkpoint or the public health department - it is best to call first and inform them of the suspicion).

Avoid close skin-to-skin contact with others until you have been tested. 

What should I do if I or someone else in my close environment has "monkeypox"?

For monkeypox, it is recommended or ordered to isolate yourself until all crusts have healed and new skin has formed - at least for 21 days.

It is also important to inform people with whom you have had close skin-to-skin contact since the onset of symptoms.
A flyer from the RKI provides further information.

How can "monkeypox" (Mpox) be treated?

As a rule, the disease heals on its own. If necessary, symptoms (e.g. fever and pain) can be treated or alleviated.

If the pain is severe, treatment in hospital may be necessary.
It is important to prevent bacterial infections of the skin lesions.
For severe courses, the drug Tecovirimat is approved.

How long do "monkeypox viruses" (Mpox-Virus) remain active?

Monkeypox viruses can probably remain contagious for long periods of time (days to weeks) on objects (e.g. sex toys) or fabrics (e.g. clothes, bed linen or towels). Therefore, good hygiene is necessary.

A leaflet from the RKI provides further information.

Does "monkeypox" only affect men who have sex with men?

No. Anyone can contract "monkeypox". It is also not a sexually transmitted infection in the strict sense. Close skin-to-skin contact, which one has not only during sex, is sufficient for transmission.

Nevertheless, the infections currently detected almost invariably affect men who have had frequent sex with changing men.

Further information is available from the Robert Koch Institute (RKI).

Important information on the CSD and Pride Season

We have compiled the most important questions and answers on the topic of "CSD and monkeypox" here.

[Translated with www.DeepL.com/Translator ]