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Last Updated: 11 September 2025

Mpox (formerly called monkeypox) is a viral disease caused by the monkeypox virus (MpoxV). 

Mpox causes a rash that can appear as bumps that turn into pimples, blisters or sores and may burst to form ulcers or scabs. Other symptoms may include fever, headache, muscle aches, backache, swollen lymph nodes, chills, and exhaustion. 

Mpox is not an STI, but it is transmitted through close physical contact with someone with symptoms, including during sexual activity. It poses a potential risk to in-person sex workers who may have intimate skin-to-skin contact with clients with the virus.

Mpox usually resolves without treatment, with symptoms lasting from 2 to 4 weeks. However, it is highly infectious from the time the symptoms start until the rash has fully healed and a fresh layer of skin has formed. Serious infection may require hospitalisation. 

Mpox (previously called monkeypox) is a viral disease caused by the monkeypox virus (MpoxV). 

Mpox causes a rash that can appear as bumps that turn into blisters or sores and may burst to form scabs. Other symptoms may include fever, headache, muscle aches, backache, swollen lymph nodes, chills, and exhaustion. 

Mpox is not classified as a sexually transmitted infection (STI). However, transmission during sexual activity is common as it is usually transmitted during close contact with someone with symptoms, including through direct skin-to-skin contact, respiratory droplets and bodily fluids. The virus can also spread through contact with objects after a person with mpox has used them, such as bedding, towels, surfaces or sex toys.

Most people with mpox recover without treatment, with symptoms lasting 2 to 4 weeks. However, it is highly infectious from up to 4 days before symptoms start until all scabs have fallen off and a fresh layer of skin has formed. More serious infections may require hospitalisation. 

Mpox can be transmitted to anyone who has close contact with an infected person or contaminated items, regardless of their identity. Currently, those considered at higher risk of mpox exposure are: 

• Gay, bisexual, or other men who have sex with men, particularly those who have multiple sexual partners or attend sex-on-premises venues.
• People who are travelling to, or returning from, countries with confirmed cases of mpox.
• People whose occupations might put them at increased risk, including sex workers, laboratory staff and healthcare workers.

Vaccination can significantly reduce the chance of mpox infection and decrease how serious your symptoms are if you do get sick. Mpox vaccination is recommended for sex workers and their sexual partners. Visit our mpox vaccination page or contact your local sex worker organisation for more information.

Information about mpox is rapidly changing, and Scarlet Alliance will continue to provide updates as they become available.

Signs and Symptoms

Mpox can present no or minimal symptoms, particularly if you have been fully vaccinated. If symptoms do appear, they usually begin between 3 and 21 days of infection. Mpox can be spread to others from up to 4 days before symptoms start until all scabs have fallen off and a fresh layer of skin has formed.

The symptoms of mpox are usually mild, and most people recover within 2 to 4 weeks. The risk of more severe symptoms is higher for infants, young children, pregnant people or people with reduced immunity.

First symptoms

In most cases, the mpox rash usually appears after other symptoms. The initial symptoms of mpox can include

• Fever
• Headache
• Fatigue/low energy
• Sore throat
• Pain in the joints, back or muscles
• Swollen glands in the neck, armpits or groin
• Rectal pain/proctitis (pain in and around the anus) 

Mpox rash

The mpox rash and lesions usually appear within 1 to 5 days after the initial symptoms. Mpox is most contagious while the rash or lesions are present. Some people with mpox may not develop a rash at all, especially if they have been vaccinated.

You can get the mpox rash on any part of your body, but it usually appears on your

• Genitals and the area around your genitals
• Anus and the area around your anus
• Face
• Inside and around your mouth
• Hands and feet

Some people have a widespread mpox rash with many sores, but others may only have a few bumps or blisters. Mpox lesions may vary in colour based on skin tone or the stage of the virus. 

The mpox rash goes through different stages before healing completely:

1. Rash starts as flat, red spots. These can be painful.
2. The spots become hard, raised bumps.
3. The bumps get larger and turn into blisters filled with clear fluid.
4. The blisters fill with pus. They can develop a small dimple in the middle.
5. The blisters crust over, become scabs and fall off.

Symptoms of mpox in vaccinated people

While vaccination does not provide complete protection from mpox, it can significantly reduce how bad your symptoms are if you develop an infection. 

Symptoms can be very mild for fully vaccinated people, and they are less likely to develop a noticeable rash. This can make it harder to identify a possible infection. Common mpox symptoms reported by fully vaccinated individuals include:

• Rectal pain/proctitis (pain in and around the anus) 
• Stomach cramps
• Increased or constant need to go to the toilet
• Severe lower back or body pain
• Sore throat and/or mouth ulcers
• Painful urination

Anyone with symptoms should seek medical attention right away. Self-isolation is recommended if you think you may have mpox.

Transmission

Mpox is not classified as a sexually transmitted infection (STI). However, transmission during sexual activity is common as it is usually transmitted during close contact with someone with symptoms, including through direct skin-to-skin contact, respiratory droplets and bodily fluids. The virus can also spread through contact with objects after a person with mpox has used them, such as bedding, towels, surfaces or sex toys.

Mpox can be spread to others from up to 4 days before symptoms start until all scabs have fallen off and a fresh layer of skin has formed. The illness usually lasts 2 – 4 weeks.

There is currently no evidence that a previous mpox infection protects against new infections. Even if you have had mpox in the past, you should do everything you can to avoid getting reinfected.

Mpox in Australia is mainly spreading through sexual activity. 

Mpox primarily spreads by:

• Direct skin-to-skin contact with rashes, blisters or sores
• Contact with semen and other body fluids from a person with mpox

Mpox can also spread by:

• Touching contaminated objects, such as bedding, clothes or personal items
• Touching contaminated surfaces
• Extended face-to-face contact with a person with mpox, but this is rare
• During pregnancy, the virus may be passed through the placenta
• Infected animals, but this is uncommon outside of Africa

Mpox can spread quickly in specific settings. Higher risk settings include:

• Households
• Sex-on-premises venues
• Events or parties involving intimate or skin-to-skin contact

Sex work activities that may be a risk for mpox transmission include

• Oral, anal, and vaginal sex or other activities that involve touching the genitals (penis, testicles, labia, and vagina), mouth or anus (higher risk)
• Hugging, massage, and kissing (higher risk)
• Touching fabric and objects used by a person with mpox that have not been disinfected, such as bedding, towels, fetish gear, and sex toys (moderate risk)
• Touching surfaces used by a person with mpox that have not been disinfected, such as massage beds, dungeon furniture and bathroom surfaces (moderate risk)
• Prolonged face-to-face contact (lower risk)

People with mpox are considered infectious:

• Until all scabs have fallen off and a fresh layer of skin has formed – this usually takes about 2 to 4 weeks
• Until all symptoms have gone and 21 days have passed since symptoms began, if there are no rashes or lesions
• For 21 days after a positive test, if there are no symptoms.

Prevention

Avoiding close contact with people with mpox or potential mpox symptoms is the most effective way to prevent infection. Vaccination can also significantly reduce the risk of mpox infection and has also been shown to decrease the severity of symptoms if you become infected. Visit our mpox vaccination page or contact your local sex worker organisation for more information.

Some things sex workers can do to reduce the risk of mpox transmission

• Know the symptoms of mpox.
• Extend health checks to check areas like the mouth, face, hands, and feet for rashes or lesions.
• Wash or sanitise your hands after health checks, or use gloves.
• If in doubt after a health check, you can refuse service or offer an alternative service, such as hand relief or mutual masturbation using gloves. 
• Use condoms, gloves and/or dental dams as barriers. Remember that they will only protect the skin directly covered by the barrier.
• Cover sex toys with condoms, and wash and re-cover them before using them on yourself or another person.
• Avoid sharing items such as drinks, cups, utensils, cigarettes, vapes, pipes, sex toys or fetish equipment that have not been disinfected.
• Avoid sharing sheets, bed linen, clothes, lingerie and towels and wash them between uses.
• Disinfect surfaces and equipment between clients.
• Wear gloves when handling used linen and bedding in a communal work environment (like a massage parlour or brothel).
• You may want to include questions about overseas travel or sex-on-premise venues in your screening process and check if your client has a fever or is feeling unwell. 
• Inform your clients of potential symptoms to look out for and tell them to let you know if they are exposed to mpox. 

If you have been in contact with a person with mpox:

• If you are not vaccinated: 
  • Talk to your doctor or healthcare provider immediately to discuss post-exposure vaccination. Getting vaccinated within 4 days (and at least within 14 days) of exposure can reduce your risk of severe illness.
  • Call your GP or sexual health clinic before attending in person so you do not risk exposing other people to the virus.
• Monitor yourself for symptoms for 21 days (3 weeks) after you were last exposed. If you get symptoms, call your GP or local sexual health clinic to get tested.
• Wash your hands regularly with soap and water or use an alcohol-based hand sanitiser. 
• Cough and sneeze into your elbow or a tissue, and immediately throw used tissues in the bin.
• Avoid settings where people are at greater risk of severe disease, including childcare, schools and healthcare facilities, except to work or seek medical attention.

If you develop potential mpox symptoms or are diagnosed with mpox:

• See your doctor or healthcare professional immediately
  • Call your GP or sexual health clinic before attending in person so you do not risk exposing other people to the virus.
• Isolate at home and avoid close physical contact with others until you return a negative test result and have no symptoms.
• Isolate until all blisters or sores have healed and a fresh layer of skin has formed to prevent further spread of the disease. 
• People with mpox can reduce their risk of passing on the virus by:
  • Avoiding close contact – including sexual contact – with other people.
  • Avoiding contact with animals.
  • Keeping sores or lesions covered by band-aids and dressings whenever possible.
  • Wearing clothing that covers any rash and sores to reduce contact with people and surfaces.
  • Washing your hands regularly with soap and water or using an alcohol-based hand sanitiser. 
  • Coughing and sneezing into your elbow or tissue, and throwing used tissues in the bin immediately.
  • Wearing a mask around people or animals if you have a sore throat, cough or any lesions in your mouth.
  • Not touching items in shared spaces and disinfecting shared spaces frequently.
  • Not sharing clothes, bedding, towels, cutlery, vapes or other personal items. 
  • Sleeping in a separate bed from other people and using a separate bathroom, if you can.
• Household members should avoid physical contact with the infected person. This includes any objects, such as linens or towels, and surfaces that have been in contact with an infected person. 

Speak to your doctor and local sex worker organisation about whether you need to notify clients or other sexual partners.

Vaccination

Vaccination can significantly reduce the chance of mpox infection and decrease how serious your symptoms are if you develop an infection. Mpox vaccination is recommended for priority groups, including sex workers and their sexual partners. 

Visit our mpox vaccination page or contact your local sex worker organisation for more information.

About the vaccine

• The best time to receive the vaccine is before you are potentially exposed to mpox.
• Most people in Australia will receive the JYNNEOS® vaccine.
• There is still a risk of mpox infection if you are vaccinated, but you may only experience mild symptoms.
• The vaccine is most effective two weeks after the second dose and provides 80% protection against mpox. 
• Vaccination is available for people 16 years and over and is given in 2 doses, at least 28 days apart. 
• For most people, the first dose will give considerable protection after roughly two weeks. However, two doses are required for the best possible protection.
• The second dose does not need to be administered immediately after 28 days.
• Waiting longer than 28 days to receive the second dose does not reduce the level of protection from the first dose.
• There is no current recommendation for booster doses, even if you are exposed to mpox. 
• People who have received smallpox vaccines can still catch mpox.

There is still a risk of infection following vaccination. Taking other steps to reduce the chance of catching or spreading mpox is still important.

Post-exposure vaccination

Post-exposure prevention (sometimes called post-exposure prophylaxis or “PEP”) is any preventive medical treatment started after possible exposure to an infectious condition to reduce the risk of getting sick. The term PEP is often used to refer to the use of HIV medication to prevent transmission, but post-exposure prevention can also be used to avoid other illnesses such as rabies, hepatitis A and B, tetanus and mpox.

Post-exposure preventive vaccination is recommended for anyone considered a high-risk mpox contact within the past 14 days. If you are exposed to mpox, getting vaccinated within 4 days can give you a high chance of avoiding the disease. Vaccination between 4 and 14 days is likely to lessen the severity of the disease.

Cost

The mpox vaccine is free for eligible people, with or without Medicare. Some immunisation providers may charge a consultation fee, so check costs when booking an appointment.

Side effects

Side effects of the mpox vaccine are common but usually mild and go away quickly. Most people have redness, swelling and pain in the spot where they received the injection. Some people also experience irritation, headache and muscle pain. 

If you are worried about any potential side effects of vaccines, talk to your immunisation provider, local sexual health clinic or GP.

Do I need a booster dose?

There is no current recommendation for booster doses.

Testing 

Here is some information about testing for mpox. You can view our list of sex worker-friendly sexual health clinics on our Where To Test page.

Testing Method

• Swab from a lesion or sore.

When to Test

• Get tested if you think you may have mpox symptoms or you think you may have been exposed to mpox. 

Other Info

• If you develop mpox symptoms or think you have been exposed to mpox, self-isolate immediately and seek testing and medical care.
• Call your GP or sexual health clinic before attending in person if you think you need an mpox test, so you can minimise the risk of exposing other people to the virus.
• If your GP is not familiar with mpox, you can share this link with them: https://sti.guidelines.org.au/sexually-transmissible-infections/monkeypox/
• Until you can see your healthcare provider, you should isolate at home and avoid close physical and intimate contact with others.
• Mpox testing is not included in routine STI testing, so you need to request it.
• Sexual health clinic testing is often bulk-billed, even if you do not have Medicare, so the test will most likely be free. 
• You may pay a fee or be bulk-billed if you see a GP.

Treatment

Symptoms typically last 2 to 4 weeks and usually go away on their own, so treatment focuses on managing the symptoms. The goal of treating mpox is to take care of the rash, manage pain and prevent complications. Early diagnosis is essential to help manage symptoms and avoid further health problems such as pneumonia, sepsis or severe skin infection. 

Treatment of symptoms may include staying hydrated and over-the-counter pain relief. Your healthcare provider will provide recommendations for your specific symptoms. More serious infections may require hospitalisation, but these are not very common.

Post-exposure vaccination

Post-exposure preventive vaccination is recommended for anyone considered a high-risk mpox contact within the past 14 days. If you are exposed to mpox, getting vaccinated within 4 days can increase your chance of avoiding the disease. Vaccination between 4 and 14 days is likely to lessen the severity of the disease.

Visit our mpox vaccination page or contact your local sex worker organisation for more information.

How might this impact my work? 

Practical Considerations

• Mpox can be spread to others from up to 4 days before symptoms start until all scabs have fallen off and a fresh layer of skin has formed.
• If you have mpox, it is recommended that you do not have sexual contact until the infection has fully healed.
• If you think you might have mpox or may have been exposed to mpox, it is recommended that you do not have sexual contact until you have been able to test for mpox.
• If you can not avoid having sexual contact, these options may reduce your risk of transmitting mpox, but there is no guarantee:
  • Offer alternative services, such as mutual masturbation, that minimise physical contact and avoid touching any rashes or sores.
  • Use condoms, gloves and/or dental dams when engaging in sexual activity. Remember that barriers only protect the skin that they cover. 
  • Keep clothing on during sexual contact or cover areas where the rash or sores are present using blankets or towels.
    • Remember that clothing or other fabrics offer limited protection and only protect the areas they cover.
    • Be careful when touching and moving clothing or other fabrics during use, as the virus can spread from your hands.
    • Contaminated items can spread the virus and need to be washed between every use. 
    • Bodily fluids can also spread mpox.
  • Avoid contact with or sharing of bodily fluids.
  • Avoid kissing and limit time spent close to the client’s face.
  • Wash or disinfect your hands and all sex toys, furniture, and any fabrics (bedding, towels, clothing) after every use.
  • Wear gloves when handling used bedding in a communal work environment.
  • Limit the number of clients you see to avoid opportunities for further infection.
  • Offer online or phone-based services, such as sexting
• It is recommended that you use condoms for sexual activity for at least 12 weeks (about 3 months) after you have recovered from mpox.
• You should inform any recent or current doubles partners if you test positive for mpox or are experiencing symptoms.
• If it is safe for you to do so, it may be helpful to share information with other sex workers at your workplace who may have also been exposed to mpox.

Legal and Reporting Considerations

• Mpox is a nationally notifiable disease in Australia, meaning that diagnosed mpox cases are anonymously reported to state or territory health departments.
• Some states and territories may have laws that criminalise sex work or having sexual contact while you have a BBV or STI. Check out our BBV, STI and the Law resource or contact your local sex worker peer organisation for more information. 
• Contact tracing of previous sexual partners (also known as ‘partner notification’) is a consideration for some BBV and STI. It should be done with consideration of the unique transmission risk and privacy needs of sex workers. Your local sex worker peer organisation can advise on any partner notification process to ensure that it is appropriate for your circumstances.