Mpox is a viral illness that produces a characteristic rash and flu-like symptoms. For most people, the infection is self-limiting and resolves within two to four weeks without specific medical treatment. While symptoms can be uncomfortable, management strategies focus on providing comfort and preventing complications. For individuals at a higher risk of severe disease, direct medical treatments are available.
Supportive Care for Symptom Management
Supportive care focuses on alleviating symptoms at home. This includes caring for the rash to prevent secondary bacterial infections by keeping lesions clean and dry. Lesions can be covered with light gauze or bandages to limit spreading the virus to other people or other parts of the body. Taking warm baths with additives like Epsom salts or baking soda can also help soothe sores.
Pain and fever can be managed with over-the-counter medications like ibuprofen or acetaminophen. These can help reduce discomfort and make it easier to rest, which is important for recovery. For painful lesions in the mouth, saltwater rinses can provide relief. In cases of painful lesions in the rectal area, sitz baths, which are shallow warm water baths, can help ease discomfort.
Maintaining hydration and nutrition is also important. Lesions in the mouth or throat can make swallowing painful, so it is important to drink plenty of fluids, like water and electrolyte-rich beverages, and to consume soft, easy-to-swallow foods. This ensures the body has the resources needed to fight the infection.
Antiviral Medications
For individuals with severe disease or those at high risk for it, antiviral medications may be considered. The most common antiviral for mpox is tecovirimat (TPOXX). This drug was originally approved for smallpox and works by inhibiting a protein the virus needs to spread between cells, stopping its progression in the body.
A healthcare provider determines eligibility for tecovirimat. It is reserved for those with severe symptoms or for people who are immunocompromised, such as individuals with advanced HIV, cancer patients, or organ transplant recipients. The medication is also considered for patients with lesions in sensitive locations like the eyes or airway, as well as for pregnant individuals and children.
Other antiviral drugs, such as cidofovir or its oral prodrug brincidofovir, may be used in certain situations, sometimes combined with tecovirimat for severe or treatment-resistant disease. Recent studies suggest that for mild-to-moderate mpox, tecovirimat may not significantly speed up recovery, reinforcing its use for more serious cases.
When to Seek Medical Intervention
While home-based supportive care is sufficient for many, certain signs and symptoms warrant immediate medical attention. One reason to contact a healthcare provider is severe pain that does not respond to over-the-counter medications, as this may require prescription-level management.
The development of a secondary bacterial skin infection is another reason to seek medical care. Warning signs include increasing redness, swelling, warmth, or pus draining from the lesions. These infections can require antibiotics to resolve. Any lesions that appear on or in the eyes should be evaluated by a professional immediately, as they can threaten vision.
Other serious symptoms can signal that the disease is progressing. These include difficulty swallowing or breathing, a stiff neck, confusion, or shortness of breath, which may indicate airway or central nervous system involvement. Problems with urination or defecation caused by extensive lesions also require medical evaluation. Prompt intervention is necessary to manage these complications.
Vaccination After Exposure
Vaccination can be used as a preventative measure after exposure to the mpox virus, a strategy known as post-exposure prophylaxis (PEP). The JYNNEOS vaccine is used for this purpose and is approved for preventing both mpox and smallpox. Receiving the vaccine after exposure can prevent the illness or reduce its severity.
The timing of vaccination affects its effectiveness. To best prevent the disease, the first dose of the JYNNEOS vaccine should be given within four days of exposure. If administered between four and 14 days post-exposure, the vaccine may not prevent illness but can still lessen symptom severity. This makes it a valuable tool for close contacts of individuals with a confirmed mpox infection.
The JYNNEOS vaccine is a two-dose series, with the second dose given 28 days after the first. Full protection is expected about two weeks after the second dose. PEP is a preventative strategy for those who have been exposed but are not yet sick; it is not a treatment for an active infection.