Mpox (monkeypox)

Mpox is an infection caused by the monkeypox virus, a virus that belongs to the same family as the smallpox virus but generally causes a milder illness.

There are two ‘clades’ of the virus – clade I and clade II. Clade II is generally associated with milder illness and was responsible for the 2022 global outbreak. Cases detected in Australia have been clade II infections to date.

The World Health Organization declared a Public Health Emergency of International Concern on 14 August 2024 for an outbreak of mpox clade I cases in Central and West Africa. This is separate to the milder (clade II) mpox cases seen in Australia.

Most people who have mpox will experience a mild illness and fully recover within 2-4 weeks.

Most people are not at risk of mpox.

Mpox can affect anyone who comes into close contact with someone with the virus. People who have had skin-to-skin or sexual contact with people who have mpox are at highest risk.

In Australia, most cases are among gay, bisexual, and other men who have sex with men acquired through sexual contact. Those at highest risk are people who:

• are travelling to outbreak areas (see smarttraveller (external site))
• have multiple sexual partners
• attend sex parties or sex on premises venues.

People who may be at higher risk of severe disease with mpox include:

• young children
• pregnant women
• older people
• immunosuppressed people

Mpox mainly spreads from person to person by direct skin-to-skin contact with someone with mpox rash, sores or scabs. This kind of contact is often during oral, anal or vaginal sex.It can also be spread by:

• prolonged face-to-face contact through respiratory droplets or oral fluids from a person with mpox (e.g. talking, singing, breathing)
• mouth-to-mouth contact (e.g. kissing)
• contact with contaminated materials (e.g. clothing, linens, towels, fabrics, or surfaces) that have been used by someone with mpox (this is usually only a risk if scabs have been shed onto the clothing or fabrics)
• contact with an infected animal (such as rodents).

Mpox can be spread from the time symptoms start, up until the lesions have crusted, all scabs have fallen off, and a fresh layer of new skin has formed underneath. This can take several weeks.

Symptoms of mpox can start 5 - 21 days after contact with the virus, such as after contact with a person with mpox or contact with contaminated materials.

People who have received a vaccine for mpox may experience a milder illness that may be very subtle (e.g. one pimple-like lesion).

Sores, rash, bumps or pimples (lesions) can be found anywhere on the body but are commonly found on:

• genitals
• anus or inside rectum, which may cause anal or rectal pain, bleeding, or bloody diarrhoea
• inside the mouth and throat as ulcers, lesions or sores, which may cause sore throat or difficulty swallowing
• face, arms, and legs.

Lesions often change and go through different stages, before forming a scab and falling off over a period of 2–4 weeks. They can appear as pimples, blisters, or sores, which can then burst to form ulcers or scabs. The lesions can sometimes be very painful and may cause scarring. Some people do not experience any pain which may make the symptoms less noticeable.

Lesions can vary in size and number with as little as a single lesion to several lesions.

People with mpox in the rectum or throat may not have a visible rash or lesion, but can still pass the infection onto others.

Symptoms of mpox may resemble sexually transmitted infections (STIs) such as herpes or syphilis as well as other infections with a rash such as measles or chickenpox.

Some people may also experience general viral symptoms at the start of their infection, such as:

• fevers or chills
• muscle or joint aches
• backache
• swollen lymph nodes
• tiredness or exhaustion
• headache.

Severe illness and death can occur in a very small percentage of people.

Most people with mpox recover without needing any specific treatments.

The illness is usually mild, and recovery takes a few weeks. However, in some people the sores can be very painful. Simple pain medications and keeping up with oral fluids help to manage symptoms.

Severe illness can occur in a very small percentage of people. Antiviral medications may be used for people with severe illness, under the guidance of a specialist doctor.

You can reduce your risk of getting mpox by:

• avoiding skin-to-skin and close contact with people who have symptoms of mpox or are confirmed to have mpox
• getting vaccinated against mpox
• avoiding handling or touching bedding, towels, or clothing of a person with mpox
• limiting the number of sexual partners
• using condoms with lubricant (condoms alone may not prevent mpox, but will protect against other STIs)
• washing your hands often with soap and water or using an alcohol-based hand sanitizer
• exchanging contact details with your sexual partners. If a sexual partner later develops mpox, this will allow you to be contacted and be given advice and/or be recommended vaccination to prevent mpox.

If you have recently attended a high-risk event (such as sex parties or sex on premises venues, particularly in affected locations that are experiencing an outbreak of mpox), you can reduce the risk of passing mpox to your sexual partners by:

• avoiding unprotected skin-to-skin contact for 3 weeks following the high-risk event, including avoiding sexual contact
• monitoring your symptoms
• seeking health care as soon as possible if symptoms develop
• exchanging contact details with your sexual partners. If you later develop mpox, your sexual partners can be contacted to provide advice and/or be recommended vaccination to prevent mpox.

Be aware that your risk of getting mpox is likely to increase as the number of your sexual partners increases.

The best time to receive the mpox vaccine is before you are exposed to the virus.

Two doses of mpox vaccine received at least 28 days apart, are required for optimal protection.

The mpox vaccine takes approximately 2 weeks to be effective.

If you are exposed to mpox, receiving a vaccination within 4 days after first exposure to mpox will provide the highest chance of avoiding the disease.

Widespread vaccination is not currently recommended due to the very low risk of infection for the general population.

Who can get the mpox vaccine for free?

Those who are at risk of getting mpox and/or experiencing severe illness due to mpox, can access the vaccine, free-of-charge. This includes people who do not have a Medicare card.

Post exposure vaccination

• Contacts of a case as determined by the Public Health Unit.

Primary preventative vaccination

The following people are recommended to be vaccinated against mpox:

• all sexually active gay, bisexual or other men who have sex with men (including cis and trans)
• sex workers, particularly those whose clients are at risk of mpox exposure
• people living with HIV, if at risk of mpox exposure 
• sexual partners of the people above
• laboratory personnel working with orthopoxviruses
• healthcare workers who are at risk for mpox. For example, working at sexual health clinics and administering vaccinations to individuals requiring post exposure vaccination

Mpox vaccination is not currently recommended for travel unless one or more of the above eligibility criteria are met.

Where can I get vaccinated?

Please contact your local immunisation provider if they provide mpox vaccinations.

Perth metropolitan area

Free mpox vaccine is available for eligible people through participating immunisation providers and sexual health clinics. Some clinics may charge for a consult – make sure you discuss this with your clinic before your appointment.

This includes, but are not limited to, the following clinics below.

• Royal Perth Hospital Sexual Health Clinic phone: 9224 2178
• GP on Beaufort (external site) phone: 9262 8600
• M Clinic (external site) phone: 9227 0734
• Sexual Health Quarters (external site) phone: 9227 6177
• South Terrace Sexual Health Clinic (external site) phone: 9431 2149
• Central City Medical Centre (external site) phone: 9225 1188
• View St Medical (external site) phone: 9227 0170

Regional Western Australia

Free mpox vaccine is available for eligible people through regional Public Health Units or participating immunisation providers.

More information on mpox vaccine

• Mpox immunisation FAQ (PDF 240KB)

If you have been in contact with a person with mpox, your local public health unit may contact you to assess your risk of developing mpox and provide advice.

If you have had contact with a mpox case and have not received a phone call or text message by public health, you should call your local public health unit (see Contact details for population/public health units).

• The public health unit will assess your level of risk and provide advice about anything you need to do.
• You may be asked to monitor for symptoms of mpox for 21 days from last contact with a person with mpox.
• You may be advised to:
  • receive a post-exposure vaccination for mpox to protect you from getting the infection
  • avoid physical or intimate contact with others including sexual activity.
  • avoid contact with animals, particularly dogs and rodents (mice, rats, hamsters, gerbils, guinea pigs, squirrels etc)
  • avoid contact with people who are at higher risk of severe disease, including people with low immunity, pregnant women, older people and young children.
  • avoid settings with young or at risk people such as early childhood education and care services, schools, aged care, healthcare settings (unless seeking medical attention).
  • wear a surgical mask when outside the home.
• If you develop symptoms, you should stay at home and contact your local public health unit to arrange testing.
  • you should stay at home, avoid others, and contact your local public health unit to arrange testing.
  • seek medical attention, if needed.

If you are going to a GP clinic, other healthcare clinic, or hospital, it is important to call ahead to let them know you may have mpox, wear a surgical mask, and cover any rash and lesions.

If your test is positive for mpox, you will be contacted by public health, who will provide advice about when you are considered no longer at risk of passing on mpox to other people. Public health may also contact you while you are staying at home to monitor your symptoms and ensure you are well.

Public health may provide you with any or all of the advice below:

• avoid physical or intimate contact with others including sexual activity
• stay at home unless undertaking essential activities
• cover any lesions and wearing a mask if you must leave home
• infect prevention and control advice such as sleeping in a separate room away from other people you live with, and avoiding sharing clothing, bedding, towels or unwashed crockery and cutlery, and practicing careful hand and respiratory hygiene
• avoid people or settings with people who may be at greater risk of severe disease.

It is not known how long the monkeypox virus remains in semen and other sexual fluids. For a further 12 weeks after recovery, people with mpox should:

• use condoms when having oral, anal, or vaginal sex
• not donate blood, cells, tissue, breast milk, semen, or organs.