Questions about the rare monkeypox virus are on the rise in tandem with reports about new cases of the zoonotic disease. Among them: How worried should you be about the recent outbreak? How does monkeypox spread? And what does a monkeypox rash look like, anyway? The first U.S. case this year was confirmed in Massachusetts on May 18, but the Centers for Disease Control and Prevention (CDC) is now tracking suspected and confirmed cases in multiple other states.
The smallpox-related virus, typically endemic to areas of western and central Africa, has also been reported in at least 15 other North American countries and European countries where it’s not normally found, according to a travel notice from the CDC. As of May 21, the World Health Organization (WHO) had received reports of 92 lab-confirmed cases and 28 suspected cases in 12 countries.
While scientists and public health officials in the U.S. and abroad continue to monitor the outbreaks, the risk to the general public is low, experts say. Case numbers are relatively small and we do have vaccines that could help prevent or treat the illness should they be needed, per the CDC. But as headlines about monkeypox continue to percolate into your newsfeed, you might have understandable concerns and questions about what you should be aware of, just in case. What are the typical signs and symptoms of monkeypox? What makes a monkeypox rash different from other skin rashes? Here’s what you should know.
What are the most common monkeypox symptoms?
The incubation period—the time between getting infected and showing the first signs of illness—for monkeypox is on average one to two weeks but can range anywhere from five days to three weeks, according to the CDC. People do not have symptoms and are not contagious during the incubation period. The next period is called the prodrome period, when the first set of symptoms occurs (not including a rash). According to the CDC, the most common early symptoms of monkeypox include fever, malaise, headache, and swollen lymph nodes. Symptoms might also include a sore throat and cough, muscle aches, backache, chills, and exhaustion.
The swollen lymph nodes may occur in the neck area, armpits, or groin, on both sides of the body or just one. Lymph nodes usually swell at the same time as the fever begins, or one to two days before the rash begins (or, rarely, at the same time as the rash begins), the CDC says. People may or may not be contagious during this time. One to three days after the fever starts—though sometimes a little longer—the monkeypox rash begins to appear.
What does a monkeypox rash look like and how does it progress?
A monkeypox rash has a very distinct appearance—clearly defined and deep-set lesions—and follow a specific progression of stages over the course of two to three weeks, as the CDC and WHO explain.
1. Enanthem
Usually the first lesions will be inside the mouth or on the tongue. This first sign of a rash marks when a person becomes contagious.
2. Macules
These flat-based lesions typically begin on the face before spreading across the body—to the arms and legs, then the hands and feet—within 24 hours. The stage lasts one to two days.
3. Papules
Typically, by day three, the rash lesions will become slightly raised and feel firm. This stage also lasts one to two days.
4. Vesicles
By day four or five, the raised lesions fill up with clear fluid. This lasts one to two days.
5. Pustules
By day six or seven, the lesions become filled with opaque, yellowish fluid. They are sharply raised, firm-feeling, and often round. Pustules will often develop a dot on top (called umbilication) and last for about five to seven days before they start to crust over.
6. Scabs
By day 14, the lesions will become crusty scabs. At this point, the lesions—which patients often describe as painful throughout the stages—will become itchy. After a week or so, the scabs start falling off. (Patches of darker or lighter skin and pitted scars where the lesions were may still remain, depending on your skin tone.) After all the lesions fall off, the person is no longer considered contagious.
Generally, there are more lesions on a person’s face and extremities than on their trunk. According to the WHO, lesions occur on the face in about 95% of cases; the palms of the hands and soles of the feet in 75% of cases; the skin inside the mouth in 70% of cases; the genitals in 30% of cases; and the eyes in 20% of cases.
Lesions on one part of the body tend to all be of about the same size, and will all be in the same stage of development in that area—though another area of lesions may be in a different stage. The number of lesions a person has can range from just a few to a few thousand, according to the WHO. In serious cases of monkeypox, there can be so many lesions close to one another that they cause big areas of skin to slough off.
When should you see a doctor?
It’s important to keep in mind that monkeypox is an exceedingly rare virus, and the odds that a random rash or any other symptoms are due to monkeypox as opposed to something much more common are quite low. For instance, the monkeypox rash may be confused with a rash from certain sexually transmitted infections (like herpes, secondary syphilis, or chancroid) and chickenpox, as the CDC points out—in which case, you’ll still definitely want to see a doctor regardless, of course.
That said, people experiencing what they believe to be monkeypox symptoms—namely, signs of the distinct and evolving rash—should get in touch with their health care provider if they have access to one. The CDC advises people who develop unexplained skin lesions on any area of the body to avoid contact with other people and seek medical care right away, whether or not they have a fever or other symptoms. You should call the medical office ahead if possible; if it’s not possible, let a staff member know right after you get to the office that you suspect monkeypox so they can take necessary precautions.
Individuals who have traveled to central or west African countries, European countries where monkeypox cases have been reported, or any other places with confirmed monkeypox cases in the month prior might want to be extra vigilant about suspicious new symptoms, according to the CDC. The same goes for anyone who has been in contact with someone infected with monkeypox (confirmed or suspected).
The CDC also says that anyone who identifies as a man and is regularly in intimate contact with other men should also be alert regarding suspect symptoms, particularly if they experience lesions in the genital or perianal area. “Based on currently available information, cases have mainly but not exclusively been identified amongst men who have sex with men seeking care in primary care and sexual health clinics,” according to the WHO.
However, it’s key to note that individuals of other demographics are getting monkeypox, and anyone can contract the disease in various ways. Monkeypox can be contracted through broken skin (like a cut), mucous membranes (the eyes, nose, and mouth), and the respiratory tract, as SELF has reported—and the CDC says that in general, human-to-human transmission is believed to primarily occur through large respiratory droplets.
Bottom line: The current outbreak is small, and we’re not dealing with a virus as contagious, as, say, COVID-19. Knowing what to be on the lookout for might help put your mind at ease a little, but monkeypox is not something to get too worked up about right now.
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