Monkey Pox


  • Human monkey-pox (MPX) is notifiable a zoonotic viral disease caused by the enveloped double‐stranded DNA Monkeypox virus (MPXV)
  • Others in its Orthopoxvirus genus include Vaccinia, Cowpox and Variola viruses
  • The Central African (Congo Basin) strain is typically more infectious and associated with more sever disease
  • Transmission via direct contact
  • Some cases globally (2022) in gay or bisexual men. Most do not have a Hx of travel
  • Clinical presentation similar to smallpox


Monkey Pox Hand Lesions
Monkey Pox



  • Fever (>38° ±rigors), headache(±severe), marked asthenia, adenopathy, myalgia
  • 1-3 days post fever the rash appears (face→trunk→hands & feet and mucous membranes)
  • Macules→papules→vesicles→crusts/scabs
  • Lesions all appear at the same stage, distinguishing them from chicken pox (varicella chicken pox)
  • Most MPX patients have significant prodromal lymphadenopathy (varicella chicken pox usually don't)
  • Most MPX patients have a significant prodromal fever (most varicella don't)
  • For most, (not immunocompromised) MPX is a self-limiting disease lasting up to 4 weeks with full recovery
  • < 10%, (age extremes or immunocompromised), resp. distress, 2° bacterial infections and encephalitis may develop
Stages of Monkey Pox - UK HSA
The stages of monkeypox. Pic: UK Health Security Agency

Differential Dx


  • Discuss with ID and Labs
  • Take advice on Ix for Varicella, HSV and Early Syphilis
  • A swab of the lesion fluid should be transported in viral transport medium
  • Inform the lab. of and label all samples as "probable MPX"
  • Alert ID/Public Health to consider contact tracing


  • Contact, droplet and airborne precautions
  • PPE with FFP2/3 mask, eye protection, disposable nitrile gloves, long-sleeved gown
  • Discuss with ID
  • The majority can be discharged and managed in the community
  • In the exceptional cases requiring admission, care is supportive
  • If very unwell/requiring admission, consider prevention / treatment of 2° bacterial infections
  • If admitted, I may consider empiric treatment of HSV or early syphilis while awaiting test results
  • Inform Public Health

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 14/04/24.