Although the World Health Organization only recently declared the end of the mpox global emergency, the virus is not gone. Chicago health authorities, for one, have identified up to 31 cases of the disease formerly known as monkeypox since the beginning of April, and the Centers for Disease Control and Prevention is raising awareness ahead of the summer.
A full schedule of two doses of the Jynneos vaccine can be up to 89 percent effective, but the CDC urges high-risk communities to take extra precautions to avoid a health crisis like we had last summer. Understanding how the virus spreads and how to prevent infection is key to complementing the protection provided by vaccines.
It’s worth noting that mpox seldom requires hospitalization and is rarely lethal: The US reported 30,235 confirmed cases between May 2022 and March 2023, with 38 deaths, the majority of both among Black people. Last year, access to treatment was limited, but there’s no reason to believe that will be the case this year, especially in major cities, as the health system is currently better equipped to respond to new mpox surges. But prevention is still crucial as the skin lesions that are one of the most common symptoms of the virus can be extremely painful without proper medication.
Matching last year’s domestic and international trends, the recent small surge in Chicago has mainly been concentrated within the community of gay, bisexual, and queer men who have sex with other men (GBMSM, in short), and their sexual network. Whether you identify as such or are currently at low risk of contracting the virus, you should know how mpox spreads and how to stay safe.
How does mpox spread?
Unfortunately, even after a year, there’s a lot about the 2022 mpox health crisis we still don’t understand, in part because it was not like previously studied mpox outbreaks in West and Central Africa. The skin lesions, for example, appeared in different locations—people infected prior to 2022 tended to have lesions all over their bodies, but during last year’s outbreak the sores mainly appeared on and around peoples’ genitals and anuses, and in their mouths. Studies have found changes in the virus’ DNA, but scientists are still trying to figure out exactly why this mutation of the disease spread so quickly and so far.
Whether or not the disease continues to behave as it did in 2022, we do know that people with mpox can be infectious from four days before their first symptoms appear to when the last lesion has completely healed, meaning all scabs have fallen off to reveal a new patch of skin. This entire process, according to the CDC, could take at least three weeks, as there’s a 17-day incubation period prior to the appearance of symptoms. On the other hand, we still don’t know if mpox patients who don’t develop any symptoms are capable of spreading the virus.
From previous outbreaks, we know mpox can spread in three ways, each of them presenting different levels of risk.
Let’s break it down.
High risk: skin-to-skin contact
By far, the most efficient way mpox jumps from one person to another is when highly infectious secretions from the rash caused by the virus make their way into the skin of a healthy person. These secretions carry more viral particles than any other fluid in an infected person’s body.
“Let’s say you touch a lesion and the virus gets on your hand. Unless you have a break in the skin, you should be ok,” says Scott Roberts, assistant professor of infection prevention at Yale University’s School of Medicine. The problem is that we tend to touch our mouths, eyes, and faces throughout the day, which means you can infect yourself with viruses lingering on your digits, he explains.
Because sex entails a lot of constant and persistent touching, involves the exchange of multiple bodily fluids, and the inherent friction can tear skin, it has become the main way mpox spreads. In 2022, sex was responsible for 82 percent of transmissions, and 84 percent of cases have been within the GBMSM community. This is why some experts believe mpox could be classified as a sexually transmitted infection or STI. But Roberts isn’t one of them.
“The reason that we’re seeing the spread through sexual contact is not that it’s a sexually transmitted infection, but rather the close, prolonged contact in an intimate encounter, where you’re touching parts of the skin, kissing, sharing bodily fluids,” Roberts says. “All of that is a good scenario for a virus to spread.”
Several studies have found traces of the mpox virus in semen, but only one of them, published by Italian researchers in The Lancet Infectious Diseases, showed the virus in the sample could replicate and actually infect another person. Unfortunately, there still isn’t enough evidence either way, so we still don’t know if mpox can spread directly through the exchange of semen, feces, or vaginal fluids.
Keep in mind that skin-to-skin contact doesn’t mean you’ll get infected by shaking hands with someone who has mpox—you’d need a high viral load for that to happen.
“It definitely requires a much longer time of close and prolonged contact if you don’t touch somebody’s lesions,” says Roberts.
Low risk: coming into contact with infected surfaces
Mpox secretions can easily seep into porous surfaces, including clothes, bedding, bandages, towels, and even upholstery. But the CDC stresses that infection through contaminated material is a low risk, and the constant and thorough disinfection of surfaces and washing of hands with soap and water should be enough to prevent the virus from spreading within a household.
Low risk: exchange of respiratory droplets
A study published by the scientific publication The Lancet in August 2022 found traces of the virus in the mouths and throats of mpox patients, which means there is a chance of infection whenever you’re exposed to their saliva or mucus. This could happen while kissing, sneezing, or simply being in close, prolonged face-to-face contact with an infected person.
But mpox is not airborne, and it doesn’t behave like COVID-19, where microscopic droplets can infect you if enough of them get into your nose and mouth. Researchers including those who worked on the Lancet study have said that the viral load in a mpox patient’s airways is nowhere near as high as the one from lesion secretions. That means transmission from respiratory fluids may be possible, but a lot less likely.
How to prevent mpox
As mentioned above, because the current and 2022 outbreaks have been mostly contained within the GBMSM community, authorities have given its members priority access to vaccines and treatment options. But even with that and greater availability of inoculations compared to last year, the CDC says only one in four people eligible to get the Jynneos shots actually have received them.
It’s because of this low vaccination rate, aggravated by the fact that vaccines are not 100 percent effective, that even if you’ve received your two doses, you should still strive to reduce your own risk of contracting mpox as much as possible.
Be smart about your sexual partners
If you are part of the GBMSM community, the safest thing you can do is reduce your number of sexual partners, the CDC says. Approach this as you did your COVID quaranteam back in 2020—you don’t have to abstain from sex, but you should limit your intimate contact to a closed circle of people you know are not taking unnecessary risks or presenting symptoms. Practicing safe sex by wearing a condom or using a dental dam is also a good idea—it not only limits the amount of exposed skin (albeit not much), but it can also protect you in case researchers confirm mpox can indeed be transmitted through sexual fluids.
You should also keep in mind that there are a lot of ways to have sex, and some don’t require touching or even being in the same room with your partner. Take this as an opportunity to be creative and explore these options as sexual alternatives.
Anonymity is another problem. We know the thrill of having sex with strangers is, well, the “strangers” part. But it’s better to stay in the know when it comes to stopping the spread of a virus. Anonymous sex rarely gives people the chance to have honest conversations about their levels of mpox exposure, potential symptoms, and vaccination status. Talking to someone before tearing off their clothes will allow everyone involved to stay safer, make informed decisions, and clearly establish how much risk you’re comfortable with.
And since you’re already having a conversation, don’t forget to exchange real names and contact information with potential partners. These include people you kiss, have penetrative sex with, and do everything in between. This will make it easier to get in touch if you end up with mpox symptoms in the future.
And if you don’t trust yourself to break the spell of anonymity, try to avoid contexts where anonymous sex is most likely to happen, like sex clubs, sex parties, and any other contexts where on-site casual sex is common.
Get the mpox vaccine
Getting vaccinated against mpox is also important for prevention. States may have different parameters for vaccine eligibility, but generally, all members of the GBMSM community and their sexual network should be able to get the two-shot inoculation. To find a site near you, contact your local health department or use the CDCs Mpox Vaccine Locator widget. You might also find vaccines available on-site at various summer events, especially those related to Pride Month celebrations.
Keep your distance and keep things clean in high-risk situations
If you know someone who’s infected with mpox, avoid seeing them until the infection has subsided. And if you live with or will otherwise be in close contact with them, maintain your distance, cover your hands with disposable gloves, wear a tight-fitting face mask when you’re near them, and put on a long-sleeved shirt and pants you can wash or place in a sealed container immediately afterward. Otherwise, make sure they’re isolated in their own space and follow CDC guidelines to manage waste and the cleaning of common areas they still have access to.
“Mpox is actually a pretty easy virus to kill,” Roberts says. “Alcohol wipes, soap and water, disinfectant, all of that really easily kills the virus.”
In general, you should regularly disinfect surfaces like kitchen counters, door knobs, and light switches, the CDC says. You should also wash your hands frequently with an alcohol-based sanitizer, or soap and water. If you’re not sure whether your cleaning products will do the trick, the Environmental Protection Agency has a list of approved disinfectants.
Don’t forget your pets
Finally, remember that mpox is a zoonotic disease, which means it can transfer from humans to certain animals, like dogs and other mammals—and vice versa. Keep your pets safe by preventing any contact between them and any infected person, even one that lives with you. If possible, ask a friend or family member in a separate household to take care of your pet for as long as the infection lasts. If you suspect your pet has mpox, the CDC recommends alerting your vet immediately so they can run tests and help you come up with a treatment and isolation plan.
This story has been updated. It was originally published on August 20, 2022.