Monkeypox is everywhere now: It's spread to every state in the U.S. And if you don't want to catch it, you need to know what kinds of activities are safe — and what you should avoid until it subsides.
The virus, which was declared a nationwide public health emergency earlier this month, has affected more than 14,000 Americans and counting, according to the Centers for Disease Control and Prevention (CDC). That may seem like a small number, especially compared with Covid. But monkeypox isn't typically found in North America or Europe at all, making the current surge both noticeable and alarming.
While it isn't particularly fatal, monkeypox can be a very painful experience that, in some cases, leaves physical scars behind. And with vaccines in short supply and testing backed up at clinics, it's at least temporarily up to you to protect yourself from infection.
Here's what you need to know if you're wondering how safe your plans to date, see friends, or go to concerts are amid the monkeypox outbreak:
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Close and prolonged contact
There's a key phrase to keep in mind when assessing monkeypox risk: close and prolonged contact.
"This virus isn't very good at infecting us, unlike Covid, so we need more dose of the virus," says Dr. Katelyn Jetelina, a University of Texas Health Sciences Center at Houston epidemiologist. "We can get more 'dose' through very close contact, or [if we are] exposed for a longer duration of time."
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The specific activity most closely associated with that level of physical contact is sexual intimacy, which Jetelina says helps explain the virus's "clear social networks of transmission." So far, about 94% of cases so far have been among men who have sex with men, she says — but that's not guaranteed to always be the case.
"This could certainly spill over to other social networks that have close contact," Jetelina says. "We haven't seen this yet, but that doesn't mean we shouldn't be prepared."
Other, more casual forms of physical contact don't seem to be major risk factors for the virus: A study published in The New England Journal of Medicine in July found that fewer than 1% of people infected with monkeypox globally had contracted the virus due to "nonsexual contact."
"Casual contact could mean shaking somebody's hand, touching a doorknob, putting on clothing [that someone else has worn], and those kinds of interactions are not necessarily high risk," says Dr. Syra Madad, a special pathogens epidemiologist at NYC Health + Hospitals.
That means venues like restaurants, movie theaters, house parties or concerts aren't likely to pose much risk. If you're still worried, keep this in mind: Risks of infection are always lower with more distance between people, less time spent together and less skin-to-skin contact.
How to decide what feels safe for you
So far, only sex — between partners of any gender or sexuality — seems to pose a truly significant monkeypox risk. Is abstinence the solution? Experts say no.
"We know that asking people to be abstinent from sex ... is not possible," says Dr. Eric Kutscher, a primary care provider and addiction medicine fellow at NYU Grossman School of Medicine.
Rather, Kutscher advises, pay attention to any potential symptoms and take them seriously if you notice them, in either yourself or a sexual partner. Check yourself and your partner for any new rashes before getting intimate. Beware of any flu-like symptoms, from fever or chills to coughs or headaches.
Most crucially, you should communicate about any potential risks with your partner.
"You often do have the ability to consent and get consent from the other person who you are going to be with, as to what risk you're comfortable with," Kutscher says. "The most important thing is for everybody to make informed decisions, and for everybody, that risk-benefit calculation may be different."
Kutscher suggests asking yourself a few questions to help determine your own personal risk calculus:
- What would a monkeypox infection mean to me?
- How would that infection impact my life or my partner's life?
- How much would completely avoiding infection affect my life?
Monkeypox's most concerning symptoms
The closest thing to a tell-tale monkeypox sign is the rash, which presents as raised, rubbery lesions on the skin. Just one lesion could be a sign of monkeypox, though some patients experience thousands of them at a time.
At least 95% of people with monkeypox have developed skin lesions, according to data from the the New England Journal of Medicine and Centers for Disease Control and Prevention.
A classic monkeypox lesion develops a dot that may feel firm at its center, similar to a pimple. The resemblance to acne can be stress-inducing, even for doctors. So how can you tell which is which?
"It's not so much how many [lesions] you have, but how different it is from your usual baseline," says Kutscher. "If you usually get acne and you have a pimple that looks like a pimple in an area you usually get pimples, it probably is a pimple."
Most monkeypox lesions aren't necessarily that painful, with the exception of ones in the genital area. Those can be excruciating, and they've affected about 47% of infected people in the U.S. If you develop new, unexpected lesions — anywhere on your body — you should contact your doctor.
That's especially true if you also have other symptoms like fever, chills, swollen lymph nodes or body aches. These flu-like symptoms often start four or five days before the rash develops and up to 21 days after exposure, but some people don't get them until after lesions appear. Others never have them at all.
Monkeypox testing typically involves swabbing at least one, and often two, lesions. If you haven't developed any lesions, but you have other monkeypox symptoms, Kutscher says you should keep yourself from jumping to conclusions: "In people with no known exposure and general [early] symptoms, it could be anything."
In that scenario, consider temporarily avoiding risky contact with others and waiting until you see lesions to visit a swamped clinic for testing. If lesions never show, and your other symptoms disappear, you're probably in the clear, says the CDC.
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