Monkeypox (MPX) is a viral illness caused by the monkeypox virus (MPXV). Historically endemic in parts of Central and West Africa, the recent global outbreak brought the question of its transmission route to the forefront of public health discussions. This information addresses the common misunderstanding surrounding whether MPX is a disease that is strictly sexually transmitted.
Defining the Transmission: Is Monkeypox Classified as an STD?
Monkeypox is not classified as a sexually transmitted disease (STD) in the classic sense, which implies transmission primarily through sexual fluids like semen or vaginal secretions. The virus is generally categorized as a disease transmitted through close, physical contact, making it transmissible during many types of intimate encounters. However, the recent global outbreak has shown an overwhelming epidemiological link to sexual activity, primarily because these encounters provide the ideal conditions for prolonged, skin-to-skin contact.
The virus’s primary mode of spread is through direct contact with infectious lesions, scabs, or bodily fluids, not necessarily through traditional sexual fluid exchange. Although MPXV DNA has been found in semen, experts emphasize that physical contact with the rash is the dominant transmission route. Sexual activity acts as a high-efficiency vehicle for this skin-to-skin contact, causing the disease to behave like an STD in current transmission patterns. Therefore, while MPX is sexually transmissible, it does not fit the definition of an infection exclusively dependent on sexual fluids.
How Close Contact Facilitates Spread
The physical mechanism of MPX transmission centers on the transfer of the virus from an infected person’s lesions to the skin or mucous membranes of a non-infected person. Direct contact with the characteristic MPX rash or scabs is considered the most common and effective route of human-to-human spread. Intimate physical contact, such as hugging, massaging, or sexual contact, provides the sustained, close proximity required for this transfer to occur.
The virus can enter the body through microscopic breaks in the skin or through the mucous membranes of the eyes, mouth, nose, anus, or vagina. During sexual activity, friction and prolonged contact ensure that any lesions present on the skin, including those in the anal or genital areas, are efficiently shared.
Transmission via respiratory secretions is also possible, though this requires prolonged, close face-to-face contact, such as kissing.
The virus can also spread indirectly through contact with contaminated objects, known as fomites, which have been in contact with infectious material. This includes sharing bedding, towels, clothing, or sex toys used by an infected person. These contaminated materials can pose a risk, especially if lesions have shed viral particles onto surfaces.
Recognizing Symptoms and Signs of Infection
Recognizing the signs of MPX is necessary to stop its transmission. The illness generally begins with a prodromal phase, lasting between zero and five days, which may include non-specific symptoms similar to the flu. These early signs often involve fever, severe headache, muscle aches, and profound fatigue.
A distinguishing feature of MPX during this early phase is the swelling of the lymph nodes (lymphadenopathy), which may occur in the neck, armpits, or groin. The rash phase typically begins one to three days after the fever starts, although some individuals have developed the rash without experiencing a prodrome.
The MPX rash progresses through several distinct stages:
- Starting as flat, red spots (macules) that become slightly raised bumps (papules).
- Evolving into fluid-filled blisters (vesicles).
- Becoming pus-filled (pustules).
- Crusting over and forming scabs.
- Finally, the scabs fall off.
The lesions are typically deep-seated, firm, and often described as painful until the scabbing phase. Lesions frequently appear first or exclusively in the genital, anal, and perioral areas. This localized rash presentation can easily be mistaken for other STDs, complicating early diagnosis. The virus is considered transmissible from the onset of symptoms until all scabs have fallen off and a new layer of intact skin has formed underneath.
Prevention Strategies for Intimate Settings
Given that close physical contact is the primary driver of spread, avoiding direct contact with lesions is the most effective prevention strategy. Refraining from all forms of close physical contact, including kissing, cuddling, and sex, with anyone who has an active rash or symptoms is advised until they have fully recovered.
For individuals who are at risk of exposure, the JYNNEOS vaccine is recommended for prevention and post-exposure prophylaxis. The vaccine is administered as a two-dose series and offers the best protection when both doses are received.
Rigorous hygiene practices are an important line of defense, especially in shared living or intimate spaces. This includes washing hands frequently with soap and water or using an alcohol-based sanitizer. Open communication with partners about recent contact history and any new rashes is necessary to reduce transmission risk. Avoiding the sharing of potentially contaminated items, such as towels, bedding, or clothing, minimizes the chance of indirect spread.