Summary

• Mpox is an infectious disease caused by the monkeypox virus (MPXV).
• It has been recorded in parts of Africa since the 1980s. In 2022, it spread globally including to Europe, North America and Australia.
• Mpox does not spread easily and usually requires close contact.
• Most people will get better by themselves in 2 – 4 weeks, however sometimes symptoms can be more severe especially in children, pregnant women and people with lower immunity.
• Mpox is diagnosed using PCR tests that can directly detect the genetic material of the virus. These tests are very accurate and can detect even small amounts of the virus.

What is mpox?

Mpox is an infectious disease caused by the monkeypox virus (MPXV), which belongs to the same family as the smallpox virus. Although there were reported cases of mpox in some parts of Africa from the 1980s, the first major outbreaks occurred in 2017, and then it spread globally including to Europe, North America and Australia in 2022.

MPXV has evolved into two different types of the virus called clade I and clade II. Clade I is more likely to cause severe illness, and it is important to note that almost all cases in Australia have been from clade II – the virus type that causes less severe illness.

Since 2023, new strains of MPXV have emerged in Africa including more serious variants of clade 1.

Mpox does not spread easily and usually requires prolonged close contact. Infection most often occurs through direct skin-to-skin contact, including during sexual activity. Mpox can also be spread by touching contaminated items such as bedding, towels or clothing. People at highest risk of mpox in Australia are men who have sex with men and their partners.

Mpox is termed zoonotic, meaning it is spread from animals to humans. It was called monkeypox because it was discovered in monkeys in a European lab in the 1950s. However, the natural habitat (reservoir) of the virus is African rodents (rats).

Why get tested?

Mpox typically causes an illness that lasts for about 2 to 4 weeks. However, even in mild cases, symptoms can be painful and recovery may take several weeks. Sometimes, it can lead to more serious illness. This is more likely in young children, pregnant women and in people with low immunity. If you are pregnant, mpox can be passed from you to your baby through the placenta.

Symptoms can begin at any time from 3 to 21 days after exposure to the virus and Mpox can be spread to other people as early as 4 days before symptoms start.

Typical symptoms

Common symptoms include:

• rashes – lesions or sores that can occur on any part of the body
• swollen glands in the neck, armpits or groin
• mouth ulcers or sores
• fever
• headache
• sore throat
• rectal pain
• joint pains – back or muscles
• extreme tiredness

The rash, which in some cases looks similar to large chickenpox sores, goes through several stages ending with scabs that fall off. The rash can look different in different parts of the body at the same time.

If you have mpox you are considered infectious:

• until all scabs have fallen off and a fresh layer of skin has formed
• until all symptoms have gone and 21 days have passed since symptoms began if there are no rashes or lesions
• for 21 days after a positive test if there are no symptoms

Treatment is aimed at relieving symptoms and includes taking common pain medicines and staying hydrated.

More severe mpox symptoms

Occasionally, symptoms can worsen and this can require specialist hospital care. Antivirals may be used if someone is at risk of severe disease. If you have severe mpox or serious complications, you may need antiviral medicines or intravenous (IV) fluids. More severe symptoms can include:

• Extensive rash covering large areas of the body
• Lesions that merge together
• Deep, painful lesions that may leave scars
• Necrotic (dead) tissue
• Significant swelling, especially of the face or genitals

Severe mpox is usually due to complications such as infection spreading to the lungs, brain or eyes, rather than just the rash itself. Symptoms can include:

• Shortness of breath or difficulty breathing
• Pneumonia (lung infection)
• Confusion or altered consciousness
• Seizures
• Eye pain and redness (conjunctivitis)
• Lesions on the eyelid or eye surface
• Risk of corneal damage and vision loss

Mpox is a notifiable disease in Australia

If your doctor finds you have mpox, they are legally required to report it to the Australian health authorities. If you have a notifiable disease, all your information is confidential, and your privacy is protected by law. It is used for planning purposes and for research. Personal identifying information is removed before sharing the information.

Vaccination
Effective Mpox vaccines are available for people at greater risk of exposure or who have been exposed to mpox within the past 14 days. You can still be infected by the virus even if you have been vaccinated. Vaccines don’t always stop a virus from entering your body — but they train your immune system to respond quickly and effectively once it does.

If you have not had the vaccine before you come into contact with the mpox virus, you have the best chance of avoiding serious symptoms if you are vaccinated within 4 days after exposure. Mpox has an incubation period (usually several days to a couple of weeks). During this time, the virus is in your body but hasn’t yet caused symptoms. If you’re vaccinated within about 4 days of exposure, your immune system can start building a defence before the virus fully takes hold. The vaccine gives your immune system a head start.

Testing

Mpox is usually diagnosed by testing the fluid or crusts taken from sores, blisters or scabs. Sometimes fluid from throat or rectal swabs are used. Your sample will be sent to a laboratory and tested. You should isolate at home until you get your result.

PCR testing (direct testing)

PCR testing is considered the best test for mpox. It detects the virus by looking directly for the genetic material of the virus. It is extremely accurate and very specific to mpox. It can detect the virus at very low levels which means it works well in the early stages of the infection.

Other tests

The mpox rash can look similar to other infections like herpes, syphilis or chickenpox (varicella). Doctors often consider a range of possibilities and may order tests for other infections including herpes simplex, varicella zoster, syphilis or bacterial infection. PCR testing can show what type of virus is present.

Having the test

Sample

Swab or biopsy.

Any preparation?

None.

Your results

Questions to ask your doctor

The choice of tests your doctor makes will be based on your medical history and symptoms. It is important that you tell them everything you think might help.

You play a central role in making sure your test results are accurate. Do everything you can to make sure the information you provide is correct and follow instructions closely.

Talk to your doctor about any medications you are taking. Find out if you need to fast or stop any particular foods or supplements. These may affect your results. Ask:

• Why does this test need to be done?
• Do I need to prepare (such as fast or avoid medications) for the sample collection?
• Will an abnormal result mean I need further tests?
• How could it change the course of my care?
• What will happen next, after the test?

More information

Pathology and diagnostic imaging reports can be added to your My Health Record. You and your healthcare provider can now access your results whenever and wherever needed.

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