Monkeypox Frequently Asked Questions: For gay, bisexual and other men who have sex with men (GBMSM)

What is monkeypox?

• Monkeypox is a tropical viral infection that causes a rash similar to smallpox (which may be itchy or painful), and a fever.
• It can also cause other symptoms such as swollen lymph nodes, muscle aches, headaches and respiratory symptoms like coughing and sneezing.
• It is caused by the monkeypox virus – which is found naturally in some animals (such as squirrels and other rodents, and monkeys) in Central and West Africa.
• It is usually an uncommon infection outside of these areas, however since 14 May 2022, clusters of monkeypox have been reported in several countries which don’t usually have monkeypox, mainly amongst persons who are thought to have had close contact with other infected patients. Investigations are ongoing.
• There are two types of monkeypox: West African monkeypox and Congo Basin monkeypox.
  • The Congo Basin type is more severe, but only the milder, West African type has been spread to countries outside Africa.
• It is not easily transmitted, and person-to-person transmission remains uncommon.
• It can, very occasionally, produce serious symptoms – sometimes, even death. Most cases who developed symptoms, however develop the following symptoms:
  • Rash (97%)
  • Fever (85%)
  • Chills (‘feeling cold’ or shivering) (71%)
  • Swollen lymph nodes (71%)

What is the incubation period of monkeypox?

• The incubation period refers to the time between being infected, and developing signs and symptoms of infection.
• The incubation period of monkeypox is usually 6 to 16 days, though this may go up to 21 days.

What are the symptoms of monkeypox?

• Monkeypox symptoms appear in two stages:
  • Initial symptoms:
• The first stage usually begins with a fever (higher than 38 deg C) of sudden onset, which may be associated with chills, followed by headache, swollen lymph nodes (in the neck, under the arms and/or in the groin) and fatigue.
• There may also be muscle ache, backache, respiratory symptoms such as cough, sneezing and runny nose, and gastrointestinal symptoms (nausea, vomiting and diarrhoea).
• Rash:
  • The rash usually appears 1 to 3 days after the fever starts.
  • The rash starts on the face and spreads to other parts of the body, and is usually seen only on the face, palms of the hands, soles of the feet and occasionally in the mouth.
  • The rash begins by looking like fluid-filled blisters or pimples, that then grow bigger and may turn into pus-filled blisters or pustules. Scabs or crusts then form, which will eventually drop off.
  • Following sexual contact, the rash may also be found initially in the genital and/or perianal areas.
  • Of note – the rash of monkeypox will always look uniform and at the same stage of development in a patient at any given time (as opposed to chickenpox, where a patient may have rashes at different stages at a given time)

How serious is monkeypox infection? 

• Most cases of monkeypox are mild, and patients usually make a full recovery.
• Very rarely, monkeypox can be severe – and even more uncommonly, it may be fatal.
• Severe illness can occur in people with very weak immune systems, and in newborns.

How infectious is monkeypox?

• Monkeypox is not very infectious.
• The person is infectious (they can transmit the infection on to other people) from the point at which they develop a fever, to the point when their rash is completely healed.

How long are people sick with monkeypox?

• Patients who become sick with monkeypox usually recover in 2 to 4 weeks, depending on the severity of their infection.

How is monkeypox diagnosed?

• If monkeypox is suspected, a fluid sample is taken from the skin rash tested for the monkeypox virus.
• In the meantime, the patient will be isolated to prevent transmission on to other people.

Can monkeypox be treated?

• No specific treatment is usually required for monkeypox.
• Any treatment that is required is usually supportive, meaning treating any symptoms, such as fever, pain or itch.  In severe cases, antivirals (such as one called cidofovir) may be considered.
• Almost all patients will make a full and uneventful recovery.
• Because patients with monkeypox are infectious, and the illness can very occasionally be a serious disease, they will be isolated in a single room and will get specialised expert treatment, and that the risk of further spread is kept to a minimum.

Are GBMSM at increased risk for Monkeypox infection? 

• No. However, there have been reports of GBMSM in Europe and the UK who have been exposed to, and infected with, monkeypox through sexual and other close, intimate contact. These reports indicate that the risk arises especially from parties and other events where sexual activity was involved.
• Hence, being GBMSM is not in itself a risk factor for monkeypox infection, but events and activities involving GBMSM have been implicated in recent outbreaks of monkeypox.

How can you catch monkeypox from other people? 

• Monkeypox is transmitted from person-to-person by:
  • Coming in contact with the rash, fluid from the skin lesions, or scabs from a person who has monkeypox, especially if you are in close contact with the sick person (such as if you are providing care for them, living with them, or if you are their sexual partner);
  • Touching objects (such as bed linen or clothing) contaminated by an infected person;
  • Being in close contact with an infected person and breathing in the virus (which can be present in their respiratory secretions) when they cough or sneeze.

I’m planning on traveling soon – what should I do with my plans? 

• Monkeypox has currently been detected in a few countries.
  • It is naturally found in certain Central and West African countries such as Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ivory Coast, Liberia, Nigeria, the Republic of the Congo and Sierra Leone.

•  There has been a large outbreak of monkeypox in Nigeria since 2017.

• • There are now reports of confirmed monkeypox in the following countries (The countries in bold have reported more than 1 confirmed case each):

• Spain 
• Portugal 
• The United Kingdom 
• Canada
• Italy
• France
• Sweden
• Belgium
• Australia
• The United States

What can I do to prevent myself from getting infected with monkeypox?

• If you are proceeding with your plans to travel to countries with monkeypox cases reported, please stick to the following advice:
  • Avoid people who are sick, especially if they have a fever or rash.
  • If you or your loved ones are sick, seek medical attention immediately.
  • If you are caring for a sick person, make sure to wear protective gear such as rubber/latex gloves, a splash-proof gown and a facemask.
  • After seeing or caring for a sick person, make sure to wash your hands thoroughly.
  • Avoid eating bushmeats if possible; if you do eat bushmeat and other meats, make sure they are thoroughly cooked, and hot through.
  • Avoid handling animals if possible; if you are handling any animals (especially sick animals), make sure you wear rubber/latex gloves and thoroughly wash your hands afterwards.
  • Avoid contact with any bedding that has been in used for a sick animal
  • Taking the usual precautions during sexual intercourse, such as the correct use of a condom (which will also reduce the risk of other STIs).

I’m planning on attending a big party while I’m travelling, and this might involve coming into contact with many people, drinking alcohol and possibly intimate contact with others – should I go ahead with it? 

• We would recommend putting your plans to attend major parties on hold for now, especially if they are happening in places with monkeypox cases have already been reported.
• Close physical contact, including sexual contact and the sharing of intimate objects (sex toys, etc) have been linked to the transmission of monkeypox.
• We would advise taking a break from these events at least until there is more information about the transmission patterns of monkeypox, and more advice can be given on how to best protect yourself.

I’m planning on hooking up with someone while I’m travelling – should I go ahead with it? 

• We would recommend taking a break from sexual hook-ups at least until there is more information about the transmission patterns of monkeypox, and more advice can be given on how to best protect yourself.
• If you do intend to continue, we would highly recommend the use of barrier protection such as the correct use of condoms – although it must be stressed that monkeypox may be transmitted from contact with body parts other than the genitals.
• We would also recommend asking your potential sexual partners if they are experiencing any symptoms such as fever, skin rash, headaches, muscle aches etc, and avoiding sexual contact if they do have any of these symptoms, and advising them to seek medical attention.

I’m going to continue being sexually active while travelling, but will use condoms and/or PrEP. Will I be protected from monkeypox? 

• The correct and consistent use of protection such as condoms and HIV PrEP will be highly effective in preventing the transmission of HIV, as well as other sexually transmitted infections.
• However, as monkeypox may be transmitted from contact with body parts other than the genitals, the use of condoms do not prevent the transmission of monkeypox, especially if there are skin lesions on other part of the body.

Will it be safe to meet up with, and possibly be sexually active with, someone who has just travelled in from a country/region with reported monkeypox cases? 

• We would recommend taking a break from sexual hook-ups at least until there is more information about the transmission patterns of monkeypox, and more advice can be given on how to best protect yourself.
• If you do intend to continue, we would highly recommend the use of barrier protection such as the correct use of condoms – although it must be stressed that monkeypox may be transmitted from contact with body parts other than the genitals.

We would also recommend asking your potential sexual partners if they are experiencing any symptoms such as fever, skin rash, headaches, muscle aches etc, and avoiding sexual contact if they do have any of these symptoms, and advising them to seek medical attention.

I have just returned from overseas, or had contact with someone from overseas, and now have symptoms (fever, skin rash, skin lesions, possibly on my genitals). What should I do now? 

• Stay calm. It is very unlikely to be monkeypox – it remains a very uncommon infection! Even if you are infected with monkeypox, it is unlikely to be serious.
• However, if you do become unwell after returning from overseas, you should always seek medical attention. If you have an illness that is suggestive of monkeypox, your doctor will contact MOH and you may be admitted for further evaluation.
• Remember to tell your doctor about your recent travel history, and if anyone you came into contact with, is sick.
• There have been cases that have been linked to the Darklands Festival in Belgium which took place between 4-9 May. If you attended this and are having symptoms now – please inform your healthcare provider.

I am HIV-positive and on treatment, and my condition is well-controlled. Should I be worried about monkeypox? 

• If your HIV is well-controlled, then the risk of severe monkeypox infection is much lower – if you do get infected with monkeypox.
• Please continue to take your HIV treatment regularly, and seek medical attention if you have any concerns, particularly you have recent history of travel to countries with confirmed monkeypox cases, or come into contact with someone who has recently travelled to those places.

More updates and information from Ministry of Health: https://www.moh.gov.sg/diseases-updates/monkeypox