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Last Updated: 1 November 2024

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 can be transmitted to any person who has close contact with an infected person or contaminated item, regardless of their identity. Currently, gay, bisexual, or other men who have sex with men who have a high number of sexual partners, sex workers and people who are travelling to countries where mpox is present are considered at higher risk of mpox exposure or infection.

Vaccination can significantly reduce the chance of mpox infection and decrease the severity of symptoms if you do become infected. 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 as the outbreak unfolds and case numbers increase, so it is important to monitor health information.

Scarlet Alliance will continue to provide updates as they become available.

Signs and Symptoms

Mpox can present no or minimal symptoms. If symptoms do appear, they usually begin 7-14 days after exposure but can be as short as 5 days or as long as 21 days. A person with mpox can be infectious from the start of their symptoms until all scabs have fallen off, leaving new skin underneath. Skin lesions may take up to four weeks to disappear after the appearance of the first symptoms. 

If infected, infants, young children, pregnant women and people who are immunocompromised have a higher risk of becoming very unwell. Serious infection may require hospitalisation.

Mpox rash

The mpox rash may occur on any body part and usually begins within 1 to 3 days of fever, headaches and body pain. 

Mpox causes a rash that is often painful. It can start as a flat sore, which develops into a blister filled with liquid that may be itchy or painful. As the rash heals, the sores dry up, crust over and fall off. The sores can look similar to chickenpox but larger. Some people may only have one or a few skin sores, and others may have hundreds. 

Some people will only have a rash on the genitals, anus and surrounding areas, but mpox sores can appear on and spread to anywhere on the

• face
• palms of the hands and soles of the feet
• inside of the mouth
• genitals and surrounding areas
• anus and surrounding areas
• eyes

Other symptoms may include

The mpox rash may be the first sign of infection, but in most cases, the rash usually follows other signs or symptoms, including

• swollen lymph nodes
• fever
• headache
• muscle aches
• joint pain
• back pain
• inflammation of the rectum and severe pain (proctitis)

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

Transmission

Mpox is not an STI, but it is usually 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.

A person with mpox can spread it to others from when symptoms start until the rash has fully healed. 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 re-infected.

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 or clothes 
• extended face-to-face contact with a person with mpox, but this is rare.
• during pregnancy, the virus may be passed to the fetus or the newborn during or after birth.

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

• Oral, anal, and vaginal sex or touching the genitals (penis, testicles, labia, and vagina) or anus of a person with mpox (higher risk)
• Hugging, massage, and kissing involving skin-to-skin contact (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)
• Prolonged face-to-face contact (lower risk)

Prevention

Avoiding close contact with people with mpox is the most effective way to prevent infection. Vaccination can significantly reduce the chance of mpox infection and has also been shown to decrease the severity of symptoms if you do 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

• Extend health checks to check areas like the mouth, face, palms of hands, and soles of feet for lesions or blisters. 
• Wash or sanitise your hands after the check if you don’t 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 toys with condoms, and wash and re-cover before using on yourself or another person.
• Avoid sharing linen, clothes and towels and wash them between uses.
• 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 in your screening practices 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 or someone you have had close contact with develops symptoms or is diagnosed with mpox: 

• If you have had contact with someone with mpox, you should monitor for signs and symptoms for 21 days (3 weeks).
• If you develop symptoms, self-isolate immediately and make an appointment with your local GP or sexual health clinic. 
• Call your GP or sexual health clinic before attending in person if you think you need a mpox test so you do not risk exposing others.
• People who have mpox should isolate themselves from others until the sores are fully healed. 
• Avoid touching items in shared spaces and disinfect shared spaces frequently.
• Wash hands regularly with soap and water or use an alcohol-based hand sanitiser. 
• If an infected person cannot isolate alone, they should wear a face mask when around other people. This includes when receiving medical care. 
• Household members and colleagues should avoid physical contact with the infected person. This includes any objects such as linen or towels that have been in contact with an infected person. 
• It is recommended that you inform your sex work colleagues if you are exposed to mpox.
• Speak to your doctor about if and how you need to notify clients. 

Vaccination

Vaccination can significantly reduce the chance of mpox infection and decrease the severity of symptoms if you become infected. Mpox vaccination is recommended for priority groups, including sex workers and their sexual partners. For more information and to find the closest vaccination clinic in your area, contact your local sex worker organisation. You can also speak to your GP or local sexual health clinic for specific vaccination information. 

About the vaccine

• The best time to receive the vaccine is before you are potentially exposed to mpox.
• Most people in unceded Australia will receive the JYNNEOS® vaccine.
• The vaccine is most effective two weeks after the second dose and provides 80% protection against mpox. 
• It is given in 2 doses, at least 28 days apart, for people 16 years and over. 
• There is still a risk of mpox infection, but if you are vaccinated, it may mean you only experience mild symptoms.
• 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 compromise the level of protection from the first dose.
• Anyone in a priority group who is planning to travel to a country experiencing a significant outbreak should be vaccinated 4-6 weeks before departure for maximum protection.
• 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, and it is still important to take other steps to reduce the chance of catching or spreading mpox.

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 prevent other conditions 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 to 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. Tiredness, headache and muscle pain can also occur after vaccination. 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, even if you are exposed to mpox. 

Testing 

Here’s some information about testing for mpox. You can view a sex worker-friendly sexual health clinic list on our Where To Test page.

Testing Method

• Swab or scraping from a blister or sore

When to Test

• Get tested if you think you may have mpox symptoms, especially if you participate in higher-risk activities, have been in contact with a known or potential mpox case in Australia, or have recently returned from overseas.
• Get tested if you think you may have been exposed to mpox, especially if you participate in higher-risk activities, have been in contact with a known or potential mpox case in Australia, or have recently returned from overseas.

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 a mpox test so you do not risk exposing others.
• Until you can see your healthcare provider, you should:
  • try to stay at least 2 metres from other people
  • If you cannot stay at least 2 metres away, wear a face mask and avoid physical contact
  • cover sores with bandaids or dressings to reduce contact with people and surfaces
  • wear clothing that covers any rash and sores to reduce contact with people and surfaces
  • avoid sharing towels or linen 
• 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 don’t have Medicare, so the test will most likely be free. 
• If you see a GP, you may pay a fee or be bulk billed. 

Treatment

Symptoms typically last 2–4 weeks and usually go away on their own or with supportive care, such as medication for pain or fever. Anyone with symptoms should seek medical attention right away and follow the advice of their healthcare provider.

The goal of treating mpox is to take care of the rash, manage pain and prevent complications. Early care is important to help manage symptoms and avoid further problems. 

Treatment of symptoms may include over-the-counter pain relief. Patients with more severe cases may need antiviral treatment.

If you are exposed to mpox but have not been vaccinated, getting vaccinated within 4 days of first exposure will provide the highest chance of avoiding the disease or reducing the symptoms. 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 spread from when symptoms first start until all sores (including scabs) are fully healed.
• If you have mpox (or if you feel sick or have a rash or open sores), it is recommended that you do not have sex until the infection has fully healed (or you have been able to test for mpox).
• If you think you might have mpox or may have been exposed to mpox, it is recommended that you do not have sex until you have been able to test for mpox.
• If you can’t avoid having sex, these options may reduce your risk of transmitting mpox, but there is no guarantee:
  • Offer alternative services such as mutual masturbation without touching each other and without touching any rash or sores.
  • Use condoms, gloves and/or dental dams when engaging in sexual activity. Remember that barriers only protect the skin that they cover. 
  • Have sex with your clothes on or cover areas where a rash or sores are present. Remember that clothing offers limited protection and only protects the covered skin. 
  • Avoid kissing.
  • Wash your hands, sex toys and furniture, and any fabrics (bedding, towels, clothing) after having sex.
  • Wear gloves when handling soiled bedding in a communal work environment.
  • Limit the number of clients you see to avoid opportunities for further infection.

• 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.
• You should inform your colleagues if you test positive for mpox or are experiencing symptoms.

Where can I get more information?

Here are some additional sources of information:

• Sex workers have always been quick to respond to protect the health of ourselves and our communities. We encourage our community to continue to monitor for any symptoms and stay safe and informed. You can contact your local sex worker peer organisation for updates and more information. 
• Australian Department of Health – Information Page on Mpox
• World Health Organization page on Mpox – Information Page on Mpox
• NSW Health has translated information factsheets available in
  • Arabic / ﺔﯾﺑرﻌﻟا 
  • Simplified Chinese / 简体中文
  • Traditional Chinese / 繁體中文
  • Portuguese / Português
  • Spanish / Español
  • Thai / ภาษาไทย
  • Vietnamese / Tiếng Việt Nam