Mpox is an infectious disease caused by a virus that has recently become more prevalent. The most prominent symptom is a rash, which can manifest as pimples, blisters, or sores, varying in severity from mild to extensive and painful. Often, an initial flu-like illness precedes the rash, characterized by headaches, fever, muscle aches, swollen lymph nodes, and fatigue.
While mpox is related to smallpox, a disease eradicated decades ago through vaccination, it is significantly less deadly and contagious. Fortunately, vaccines and treatments developed for smallpox are also effective against mpox. Despite being less severe than smallpox or COVID-19, the skin lesions caused by mpox can be intensely painful.
Key Symptoms of Mpox
The primary symptoms of mpox typically include:
- Fever
- Intense headache
- Muscle aches
- Back pain
- Low energy
- Swollen lymph nodes
- A skin rash or lesions
The hallmark symptom is the skin rash or sore, which can resemble pimples or blisters. This rash usually appears within one to three days after the onset of fever. The lesions can be flat or slightly raised, filled with clear or yellowish fluid, and eventually crust over, dry up, and fall off. The number of lesions can range from a few to several thousand, with a tendency to concentrate on the face, palms of the hands, and soles of the feet. They can also be found on the mouth, genitals, and eyes.
Symptoms typically resolve on their own within 2 to 4 weeks without specific treatment. If you suspect you have mpox symptoms, it is crucial to seek advice from a healthcare professional. Due to increased awareness, understanding of transmission, and community engagement, the number of confirmed mpox cases has been declining.
Monkeypox (Mpox) Treatment and Prevention
How Mpox Begins and Spreads
Mpox can be challenging to diagnose initially due to its varied presentation. Some individuals experience flu-like symptoms before the rash appears, while others may notice the rash first, with flu-like symptoms developing later or not at all. Depending on the location, some mpox sores may be present in areas that are painful but not easily visible, particularly if the rash begins in the mouth or internal areas of the anus or genitals. There is no single way to identify the onset of mpox, but its transmission methods and protective measures are well-understood.
Mpox can spread through:
- Direct contact with mpox sores or scabs from an infected animal or person.
- Contact with bodily fluids such as saliva, respiratory secretions, blood, or other fluids from an infected individual or animal.
- Contact with contaminated materials like clothing, bedding, or towels used by an infected person or animal.
- Vertical transmission from a pregnant woman to her fetus during pregnancy or at birth.
Specific situations that facilitate mpox transmission include close, intimate contact such as cuddling, kissing, or sex. Less commonly, transmission may occur through very close proximity during talking, sneezing, or coughing. Skin-to-skin contact and sharing personal items like towels, bedding, or sex toys are also risk factors. Bites or scratches from an infected animal, or consuming the meat of an infected animal, can also lead to infection.
While anyone can contract mpox, the global outbreak has disproportionately affected men who have sex with men (MSM). However, it is essential to remember that the disease can affect anyone.
The Mpox Rash: Stages of Progression
The rash caused by mpox progresses through several stages over approximately two to four weeks. It is important to note that the rash is considered contagious until all skin lesions have healed and new skin has formed over the scabs.
Stage One: Macules
Macules appear as flat, round pink spots without any elevation. This stage typically lasts for one to two days.
Stage Two: Papules
Following macules, papules are flat pink spots that become raised bumps. This stage also lasts for one to two days.
Stage Three: Vesicles
In this stage, the raised bumps transform into fluid-filled blisters containing clear fluid. This phase lasts for another one to two days.
Stage Four: Pustules
Vesicles evolve into opaque, pus-filled bumps. These pustules enlarge, become firmer, and may develop a small indentation in the center. A small, crusted scab may begin to form at this stage, which can take about a week to develop.
Stage Five: Scabs
Over one to two weeks, the pustules crust over and form scabs. These scabs remain for about a week before they begin to fall off, revealing new skin underneath.
It is important to recognize that individual lesions may progress through these stages at different rates, and multiple lesions at various stages can be present simultaneously. New lesions may continue to appear as the illness progresses.
Distinguishing Mpox Rash from Other Conditions
Especially in the early stages, differentiating an mpox rash from other skin conditions can be difficult. If you have been in close contact with someone diagnosed with mpox or are considered at higher risk of exposure, consult a doctor. Several conditions can present with a rash similar to mpox, including:
- Chickenpox: This rash can resemble mpox but is typically seen in children.
- Shingles: A viral infection causing a painful rash, often appearing as a single stripe of blisters on one side of the body, but can occur anywhere.
Other conditions like acne keloidalis nuchae can also present with bumps on the neck or scalp that might be mistaken for mpox. A dermatologist is a medical doctor specializing in skin, hair, and nail conditions and can provide an accurate diagnosis.
Diagnosis and Prevention
Diagnosing mpox involves evaluating symptoms, their progression, and often a skin sample test. Doctors may also conduct tests to rule out other conditions like chickenpox, measles, bacterial skin infections, scabies, or smallpox. A key differentiator from smallpox, if lymphadenopathy (swollen lymph nodes) is present, is that smallpox typically does not present with this symptom.
To reduce the risk of contracting mpox:
- Avoid traveling to areas where mpox is reported.
- Refrain from interacting with animals that may carry the virus.
- Avoid touching materials potentially contaminated with the virus.
- Wash your hands thoroughly with soap and water.
While there is no specific cure for mpox, a vaccine is available for use during outbreaks. Individuals diagnosed with mpox are advised to isolate until the disease runs its course, typically lasting 2-3 weeks. Consulting a dermatologist is recommended if you develop symptoms resembling mpox.
It is important to note that individuals can become contagious during the prodromal (early symptom) period, which may include fever, malaise, headache, sore throat, cough, and swollen lymph nodes. Lymphadenopathy, particularly in the neck, armpits, or groin, is a characteristic feature of mpox. In some cases, people may develop a rash without a preceding prodrome, and during the recent global outbreak, many patients have presented with localized lesions rather than the diffuse rash historically associated with the disease.
The evolution of lesions typically progresses through macular, papular, vesicular, and pustular stages before scabbing over and desquamating (shedding). Pitted scars or areas of altered skin pigmentation may remain after scabs fall off. A person is considered contagious during the prodromal period and while lesions are present until fully healed.