The 101 on monkeypox in South Africa — what we know for now!

The first case of monkeypox has been identified in South Africa. This follows ongoing outbreaks in several European countries, United States, Canada, Morocco and the United Arab Emirates. When it comes to news of infectious diseases, it’s normal to have questions and concerns. But what is monkeypox and should you be worried?

Here we answer the big questions on monkeypox.

1. What is monkeypox?

Monkeypox is a rare infection that is caused by the monkeypox virus. It is related to the smallpox virus but is less severe.

There are two known types of monkeypox virus - the West African Clade and the Central African Clade. The current outbreak is caused by the less severe West African Clade. The World Health Organization (WHO) has a fact sheet on monkeypox that provides more information. 

2. How is monkeypox passed on?

Monkeypox spreads in different ways. The virus can pass from person to person through: 

• direct contact with the infectious rash, scabs, or body fluids of someone with monkeypox,
• contaminated surfaces such as towels or bedding used by someone with monkeypox,
• coughs or sneezes of a person with monkeypox, 
• during intimate physical contact, such as kissing, cuddling, or sex.

3. What are the symptoms of monkeypox?

The symptoms of monkeypox include fever, headaches, muscle and back pain, fatigue (tiredness), skin rash and sores.  In most cases, the skin rash or sores will appear around 3 days after the first symptoms. 

The rash or spots can change and go through different stages before finally forming scabs, which later fall off.

Symptoms last between two and four weeks.

4. How deadly is monkeypox?

The good news is that monkeypox is usually mild and very rarely leads to death. Severe cases are more common among children and those with immune deficiencies. There is a range of complications that can occur. These include secondary infections, bronchopneumonia, sepsis, encephalitis and infection of the cornea.

5. Can monkeypox be treated and how?

Most people will recover from monkeypox without any specific treatment. Doctors normally only need to treat a patient’s symptoms, like fever or rash, to help reduce discomfort. In most cases the illness is mild and hospitalisation is not needed. There is no specific treatment for monkeypox. But, because it is similar to the smallpox virus, antiviral drugs that are used to treat smallpox can also be used to treat monkeypox. 

Currently, there are two approved drugs for treatment of smallpox, known as TPOXX (tecovirimat) and Tembexa (brincidofovir). But these are not available everywhere. 

6. What should I do if I have monkeypox?

If you think you have symptoms or have been in close contact with someone with monkeypox, contact your health provider for advice, testing and medical care. Your health provider will collect a sample from you for testing so that you can get tested and receive the care you need.

If possible, self-isolate, and avoid close contact with others. Do not share bedding or towels with anyone. As well as these steps, you should clean your hands regularly to protect others from infection.

7. Can I get monkeypox from having sex? Will condoms protect me?

Though it is still not clear if monkeypox can spread through semen or vaginal fluids, monkeypox is not a sexually transmitted infection (STI). It is, however, passed on through close personal contact which is a big part of sex. This means that condoms will not protect you from monkeypox during sexual intercourse. 

8. Why does it appear to affect men who have sex with men?

When the South African outbreak began, the Health Minister, Dr Joe Phaahla, stated that monkeypox is currently dominant among men who have sex with men. While the data does show that the majority of cases in the current outbreak affect gay and bisexual men and men who have sex with men, it is important not to misunderstand the statement. 

Monkeypox is often passed on from person to person through direct close contact. This means that if one person becomes ill it can easily spread through their close contacts - for example, within a household or among sexual partners. This is how it might spread through a group of people. This does not mean that only one community is affected.

Many scientists and public health experts have warned against the narrative that monkeypox is only a risk among men who have sex with men. There are concerns that this is likely to be misinterpreted by the public causing stigma against these groups. It may also stop people from seeking the medical help they need.