What You Need to Know about Monkeypox

SMHS professor Tara Palmore answered questions about the infectious disease, including how it is spread and treatment.

September 9, 2022

SMHS professor Tara Palmore

SMHS professor Tara Palmore (William Atkins/GW Today)

With cases of monkeypox (MPX) continuing to occur across the nation, and with the academic year fully underway, it is important for the entire George Washington University community to be updated about this infectious disease and understand ways to avoid transmission. There has been a small number of MPX cases among members of the university community, and experts anticipate there may be additional cases of MPX this fall.

The university’s public health and medical experts have been closely monitoring developments related to MPX and collaborating with local, regional and federal health officials to understand the virus, its prevalence in the District and surrounding region, and how best to prevent its spread. GW will continue to provide support, resources, and updates as the semester continues.

Tara Palmore, director of the Travelers’ Clinic at the George Washington University Medical Faculty Associates (MFA) and professor of medicine at the GW School of Medicine and Health Sciences, recently provided key information about MPX, including what to do if you suspect you may have contracted it.

Q: What is MPX?

A: MPX is a virus in the Orthopoxvirus family. It is a milder relative of smallpox. MPX was first discovered in the 1950s in monkeys, but its reservoir in nature is small mammals in Central and West Africa. For decades, MPX has caused infections in humans who had contact with animals and then spread it through person-to-person transmission.

Q: How contagious is MPX, and how is it spread? How can a person avoid MPX?

A: The virus is not exceedingly infectious. There is no evidence of airborne spread, nor of spread from casual contact with surfaces, such as touching a handle that an infected individual touched. MPX spreads via close skin-to-skin contact, whether through mucous membrane contact and contact with infectious body fluids. It may also spread through contact with items such as bed linens that have been used by an infected person.

Individuals can prevent MPX exposure by avoiding close contact with skin, clothing, towels or bedding of infected people. In rare cases, it may also spread by respiratory droplets; however, in the current outbreak, skin-to-skin contact has been the primary mode of transmission. Condom use will not prevent MPX transmission.

Q: What are symptoms of MPX?

A: MPX disease may begin with fever and fatigue, but those symptoms do not necessarily occur at the onset and sometimes do not occur at all. Some patients develop swollen, tender glands in the head, neck, underarm or groin. Skin lesions arise on almost any part of the body, including the limbs, trunk, genital and anal areas, head and neck, and inside of the mouth. The skin lesions can look like small bumps, blisters or pimples, and they are frequently itchy, painful or both. Some individuals develop proctitis, which is a painful inflammation of the rectum. These symptoms may occur in sequence or at the same time. 

Q: How are patients diagnosed?

A: To make the diagnosis, a provider swabs multiple lesions and sends the sample for a test that detects all non-smallpox Orthopoxviruses, including MPX. A positive test is a presumptive diagnosis of MPX, and the patient is notified that they have a positive test. The sample then goes to the Centers for Disease Control and Prevention (CDC) for confirmatory testing. The virus is sequenced to verify that the sample indeed contains MPX. In addition, the CDC analyzes the sequences to study the genomic epidemiology of the outbreak and better understand the dynamics of transmission, and it monitors for important genetic mutations.

Q: Which treatment options are available?

A: Most individuals with MPX infection recover with symptomatic treatment and do not need specific antiviral medication. Symptomatic treatment includes topical creams to relieve itching and pain, anti-inflammatories such as ibuprofen and pain medications if needed. An antiviral medication called tecovirimat (brand name TPOXX) is available through an expanded access protocol from the CDC for those who have severe MPX disease or infected persons with immune vulnerabilities that put them at risk of developing severe disease.

Q: What’s an important takeaway about MPX that more people should know?

A: The media circus and public stigma surrounding MPX have already been very hurtful to communities most affected by the disease. It is important to be sensitive and avoid perpetuating stigma and to encourage those with symptoms to seek testing and care.

Post-exposure prophylaxis with the smallpox vaccine is available through the health department to those who have had high-risk exposures to persons with confirmed MPX infection. Pre-exposure prophylaxis is being offered to high-risk individuals as vaccine supplies are available.