Mpox Symptoms In Adults

  • Yujin Wang Master of Science – MSc, University of Sheffield, England
  • Jo Witherstone Master of Science Cancer Care, University of the West of England
  • Ellen Rogers MSc in Advanced Biological Sciences, University of Exeter

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Introduction

Mpox (previously known as monkeypox) was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) from July 2022 to December 2023. During this timeframe, there were 93,030 confirmed cases of Mpox worldwide, which led to 176 deaths across 117 countries.1 More information and data from this outbreak is available here.

What is mpox?

Mpox is a viral infection that was first seen on the skin of monkeys. Mpox is a zoonotic disease that can be transmitted between humans and monkeys through direct or indirect contact.2 In 2022, the WHO suggested replacing the disease name “monkeypox” with “mpox” to reduce the discrimination against patients with this disease.

Mpox is an infectious disease caused by the monkeypox virus. Mpox symptoms are similar to the symptoms of smallpox and include a painful rash, enlarged lymph glands, and fever. Luckily, however, mpox is much less dangerous than smallpox.

How to distinguish between mpox, smallpox, and chickenpox

Mpox, smallpox and chickenpox all cause similar symptoms such as fever, rash, myalgia, chills and headache. Mpox and smallpox are related and belong to the same family of poxviruses, whilst chickenpox is a type of herpesvirus.3 The smallpox vaccination may prevent mpox but only in patients who have not previously had mpox. The most notable difference between mpox and smallpox is that mpox can cause lymphadenopathy (swelling of the lymph nodes).4

How does mpox spread?

Understanding how mpox spreads is very important in developing strategies to prevent further outbreaks of the disease. 

The number of human mpox cases has risen since the 1970s, especially in the Democratic Republic of the Congo.5 Mpox virus can be spread through direct or indirect contact with skin lesions (abnormal or wounded skin), bodily fluids, respiratory droplets, or via contaminated fomites of monkeys carrying the virus.6

Symptoms of mpox

How long does it take for mpox symptoms to onset?  

According to the WHO, the incubation period of mpox can range from 5 to 21 days.7 Therefore, an infected person may not demonstrate symptoms immediately. The virus can hide and survive in our body for up to 3 weeks - and spread to other people too. Interestingly, mpox does not spread as easily as smallpox or chickenpox, with transmission generally requiring individuals to come into very close contact with infected bodily fluids or objects, such as bedding or clothing. Mpox can be effectively prevented by avoiding intimate physical contact and contaminated objects.

What happens after mpox symptoms appear?

The infection symptoms can be divided into two phases: the febrile phase and the skin eruption phase. 

Phase DurationSymptoms
Febrile phase1 to 3 days- Fever
- Intense headache,
- Lymphadenopathy (swelling of lymph nodes)
- Back pain
- Myalgia (spinal pain)
- Intense asthenia (lack of energy and strength)
Skin eruption phase.2 to 4 weeks- Skin lesions including:
- Macules (lesions with a flat base)
- Papules (raised firm painful lesions)
- Vesicles (filled with clear fluid)
- Pustules (filled with pus), followed by scabs or crusts*

Treating and managing mpox

It is very important to recognise the symptoms of mpox early to reduce the risk of severe illness progression, and the disease spreading. Early intervention may help control a patient’s pain in the skin eruption phase, especially for those with pre-existing conditions such as human immunodeficiency virus (HIV).   

Mpox is rarely fatal and, according to the Centers for Disease Control and Prevention (CDC), most adults recover fully without treatment within 2 to 4 weeks.8 In fact, there is currently no active or specific treatment for mpox. However, some people with immune deficiencies may need specific or intensive treatment.

The National Health Service (NHS) suggests that individuals infected with mpox should isolate at home until fully recovered.

How can the public protect themselves against mpox?

Mpox is a worldwide problem. It is important to prevent this disease from spreading because mpox can significantly affect your confidence and day-to-day activities.9 Getting vaccinated can effectively reduce or stop this disease from spreading among people in high-risk groups10.

According to the NHS some people may also benefit from getting the smallpox vaccination (MVA), especially:

  • Healthcare workers who are caring for patients with confirmed or suspected mpox. Healthcare workers will usually be offered 2 doses of the smallpox vaccine.
  • Homosexual or bisexual individuals who have sex with men
  • Individuals who have multiple sexual partners or who participate in group sex.
  • Individuals who have had close contact with someone with mpox are advised to get a dose of the vaccine within 4 days of exposure
  • Anyone planning to travel to West or Central Africa, but especially those with skin damage or a weak immune system

Potential complications of mpox

  • Respiratory problems: The virus can cause sore throat, cough, and/or shortness of breath. However, in some rare cases, it may cause serious complications including pneumonia.11
  • Gastrointestinal symptoms: mpox patients may experience a reduced appetite. Anorexia was the most frequently reported gastrointestinal problem, but vomiting, nausea, abdominal pain and diarrhoea are also common symptoms.12
  • Skin problems: Patients usually have bumps, pimples or blisters on their skin and that can be painful. Lesions may occur anywhere on the skin, including the face, mouth, hands, feet or sexual organs. Some people may only have one or two bumps, or only experience a rash.

Summary

Mpox is a zoonotic viral disease first seen in monkeys. Like smallpox, mpox is a poxvirus, but it is much milder and rarely causes life-threatening complications or death. Mpox can spread via bodily fluids or infected objects that carry or contain mpox virus, meaning it can be spread via close contact. Symptoms of mpox usually appear between 5 to 21 days and include a painful rash and abnormal skin lesions. Most patients recover fully at home without treatment, but immunocompromised individuals may need special care. The smallpox vaccine is recommended by the NHS for high-risk groups in the population at risk of infection.

FAQs

What should I do if I think I have mpox?

If you are experiencing mpox symptoms, or you have been in close contact with someone with mpox, you should stay at home and call a sexual health clinic or 111 for advice. Isolate from others and refrain from kissing, hugging and sexual activities. It is a responsible action to contact individuals whom you have had intimate contact with within the last 3 weeks. Until you have a clear negative result, isolate, avoid direct contact with other people, and wear a mask and gloves if you have to go out. Here is the NHS’s advice.

What symptoms should I speak to a doctor about?

In adults, mpox causes similar symptoms to chickenpox and smallpox. If you have travelled to a high-risk area (for example western or central Africa) in the last 21 days and are experiencing any of the below symptoms, please contact your GP as soon as possible:

  •    Fever and chills
  •    Headache and body aches
  •    Fatigue and malaise
  •    Skin lesions and rashes
  •    Lymphadenopathy (swollen lymph nodes)

What precautions do I need to take, if I have mpox and cannot avoid contact with another individual (baby or child)?

Don’t worry too much. Mpox does not spread that easily, and infection is mainly through infected bodily fluids or contaminated objects. However, it is important that medical professionals wear personal protective equipment when caring for infected patients, and infected individuals wear protective clothing (mask, gloves etc) when around their families and friends.

References

  1. World Health Organisation. Mpox (monkeypox) Outbreak [Internet]. [cited 2024 Feb 7]. Available from: https://www.who.int/europe/emergencies/situations/monkeypox.
  2. Moore MJ, Rathish B, Zahra F. Mpox (Monkeypox). Nurse Pract [Internet]. StatPearls Publishing; 2023 [cited 2024 Feb 6]; 48(4):13–20. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574519/.
  3. Centers for Disease Control and Prevention. Smallpox & Other Orthopoxvirus-Associated Infections [Internet]. [cited 2024 Feb 7]. Available from: https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/smallpox-other-orthopoxvirus-associated-infections.
  4. Jayswal S, Kakadiya J. A narrative review of pox: smallpox vs monkeypox. Egypt J. Intern. Med. [Internet]. 2022 [cited 2024 Feb 7]; 34(1):90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9746567/
  5. Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. The changing epidemiology of human monkeypox—A potential threat? A systematic review. PLoS Negl. Trop. Dis. [Internet]. 2022 [cited 2024 Feb 6]; 16(2):e0010141. Available from: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010141.
  6. Centers for Disease Control and Prevention. How It Spreads | Mpox | Poxvirus  [Internet]. [cited 2024 Feb 7]. Available from: https://www.cdc.gov/poxvirus/mpox/if-sick/transmission.html.
  7. Centers for Disease Control and Prevention. Signs and Symptoms | Mpox | Poxvirus [Internet]. [cited 2024 Feb 7]. Available from: https://www.cdc.gov/poxvirus/mpox/symptoms/index.html.
  8. Centers for Disease Control and Prevention. What to Do If You Are Sick | Mpox | Poxvirus  [Internet]. [cited 2024 Feb 7]. Available from: https://www.cdc.gov/poxvirus/mpox/if-sick/what-to-do.html.
  9. Ahmed SK, Abdulqadir SO, Hussein SH, Omar RM, Ahmed NA, Essa RA, et al. The impact of monkeypox outbreak on mental health and counteracting strategies: A call to action. Int. J. Surg. [Internet]. 2022 [cited 2024 Feb 7]; 106:106943. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9533932/
  10. NHS. Mpox [Internet]. [cited 2024 Feb 7]. Available from: https://www.nhs.uk/conditions/mpox/.
  11. Ortiz-Martínez Y, Montalvo-Campana M, Saul Z, Gopalratnam K, Wolff AJ, Rodríguez-Morales AJ. Respiratory Manifestations and Complications of Monkeypox. Int. J. Mycobacteriol. [Internet]. 2023 [cited 2024 Feb 7]; https://journals.lww.com/ijmy/fulltext/2023/12030/respiratory_manifestations_and_complications_of.24.aspx.
  12. Simadibrata DM, Lesmana E, Pratama MIA, Annisa NG, Thenedi K, Simadibrata M. Gastrointestinal Symptoms of Monkeypox Infection: A systematic review and meta-analysis. J. Med. Virol. [Internet]. 2023 [cited 2024 Feb 7]; 95(4):e28709. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.28709.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Yujin Wang

Master of Science – MSc, University of Sheffield, England

Yujin is a first-year master’s student in Health Technology Assessment and Reimbursement. She has several years of experience in medical and health reimbursement in public sectors. She is passionate in health related research and health promotions.

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