Understanding Mpox (Monkeypox): Symptoms, Visual Guide, and Treatment Options

Mpox, also called monkeypox, is a viral illness closely related to smallpox, characterized by fever, swollen lymph nodes, and a distinctive rash with lesions. These lesions often appear on or near the genitals, anus, and various other body parts.

As a zoonotic disease, mpox can be transmitted between animals and humans, as well as between humans themselves.

There are two main strains of the mpox virus: the West African strain and the Congo Basin strain.

Historically, mpox cases were mostly confined to central and western Africa. However, since 2022, the West African strain has been identified in 94 countries worldwide, including regions where the virus is not typically found.

This article explores the causes, symptoms, diagnosis, transmission, and treatment of mpox in detail.

In November 2022, the World Health Organization (WHO) renamed “monkeypox” to “mpox” to minimize stigma and other concerns. This article reflects that updated terminology where applicable.

What Causes Mpox?

Mpox is caused by the mpox virus, a member of the Orthopoxvirus genus, which also includes the virus responsible for smallpox.

The disease was first identified in 1958 following two outbreaks among research monkeys, which led to its original name. The first human case was reported in 1970 in the Democratic Republic of the Congo.

Recognizing Mpox Symptoms

Symptoms of mpox resemble those of smallpox but are generally less severe.

After exposure, symptoms typically emerge within 6 to 13 days, though the incubation period can range from 5 to 21 days.

Initial symptoms often include:

• Fever, usually the first sign
• Headache
• Muscle aches
• Back pain
• Fatigue
• Chills
• Swollen lymph nodes (lymphadenopathy)

A rash usually develops 1 to 3 days after fever onset, commonly affecting:

• The face (most frequent site)
• Palms of the hands
• Soles of the feet
• Mouth
• Genital area
• Eyes, including conjunctiva and cornea

Rash appearance may precede or follow flu-like symptoms, and some individuals may experience rash alone.

The rash progresses through stages:

• Macules: flat, discolored spots
• Papules: slightly raised bumps
• Vesicles: fluid-filled blisters
• Pustules: pus-filled lesions
• Scabs: crusts that eventually fall off

Symptoms generally resolve within 2 to 4 weeks without specific treatment.

Visual Identification of Mpox

Below are images illustrating mpox lesions in humans for better recognition:

Possible Complications of Mpox

Complications can include:

• Bronchopneumonia
• Sepsis
• Encephalitis (brain inflammation)
• Corneal infection, potentially leading to vision loss
• Secondary bacterial infections

Severe cases may involve merging lesions causing extensive skin loss.

Geographical Distribution of Mpox

Traditionally, mpox was endemic to tropical rural areas in central and western Africa, including countries such as:

• Benin
• Cameroon
• Central African Republic
• Cote d’Ivoire
• Democratic Republic of the Congo
• Gabon
• Liberia
• Nigeria
• Republic of the Congo
• Sierra Leone
• South Sudan

The Democratic Republic of the Congo reports the majority of cases historically.

Since August 2022, mpox cases have been identified in 87 additional countries worldwide, totaling over 39,000 cases.

On July 23, 2022, WHO declared the mpox outbreak a Public Health Emergency of International Concern.

How Does Mpox Spread?

Mpox transmits through direct contact with the virus present in:

• Blood
• Body fluids
• Skin or mucous membrane lesions
• Respiratory droplets during close human-to-human interaction

It can also spread via contaminated objects such as fabrics and surfaces.

Pregnant individuals can transmit the virus to their fetus through the placenta.

The CDC highlights intimate contact as a key transmission route, including:

• Hugging, massaging, or kissing
• Oral, anal, or vaginal sex
• Touching the genitals or anus of an infected person
• Prolonged face-to-face exposure
• Contact with contaminated items like bedding, towels, or sex toys

Animal bites or scratches and consumption of infected animal meat can also spread the virus.

Ongoing research aims to clarify transmission from asymptomatic individuals and via other bodily fluids such as vaginal secretions, semen, urine, or feces.

Is Mpox Fatal?

Mpox is rarely deadly. Approximately 99% of individuals infected with the West African strain survive. This strain is responsible for the current global outbreak.

Higher risk of severe illness or complications exists in:

• Immunocompromised individuals
• Children under 8 years old
• Pregnant or breastfeeding persons
• Those with eczema history

Secondary bacterial infections worsen outcomes.

The Congo Basin strain is more severe, with a fatality rate near 10%.

Mpox Cases in the U.S. (2022)

Prior to 2022, U.S. mpox cases were mostly linked to international travel or contact with infected animals.

From May 2022, mpox cases surged globally, including in countries where it was previously uncommon.

As of August 17, 2022, the U.S. reported 13,517 cases, with the highest numbers in:

• New York
• California
• Florida
• Texas
• Georgia

On August 4, 2022, mpox was declared a public health emergency in the United States.

Treatment for Mpox

Currently, no specific cure exists for mpox, but the disease is usually self-resolving.

Medications used to control outbreaks and reduce transmission include:

• Vaccinia vaccine (smallpox vaccine)
• Vaccinia immune globulin
• Antiviral drugs in animals
• Tecovirimat (TPOXX), an antiviral approved for smallpox
• Brincidofovir (Tembexa), an antiviral for smallpox in adults and children
• Cidofovir, typically for cytomegalovirus eye infections but sometimes used in mpox cases

Symptom management involves pain relievers, topical creams, and antihistamines.

Vaccination and Prevention

The WHO states that smallpox vaccination is about 85% effective in preventing mpox.

Two vaccines, JYNNEOS and ACAM2000, are available for mpox prevention.

The CDC recommends vaccination for individuals exposed to mpox or at high risk, including those:

• Identified as close contacts of mpox cases
• With recent sexual partners diagnosed with mpox
• Having multiple recent sexual partners in areas with mpox cases
• Working in environments with orthopoxvirus exposure

Additional preventive measures include frequent handwashing and avoiding contact with infected individuals or contaminated items.

Screening and Diagnosis

If exposed to mpox, consult a healthcare provider to assess the need for testing.

Diagnosis is typically confirmed by:

• Laboratory testing of lesion fluid or scabs using polymerase chain reaction (PCR)
• Skin biopsy to detect viral presence

Blood tests are generally not reliable due to brief viremia.

Summary

Mpox is a viral zoonotic disease transmissible between animals and humans, as well as between humans.

Initial symptoms include fever, muscle pain, and swollen lymph nodes, followed by a rash that forms fluid-filled lesions primarily on the face, genitals, and extremities.

The rash progresses through defined stages before healing.

Vaccination, good hygiene, and avoiding contact with infected individuals or contaminated objects are key to preventing mpox infection.

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