Monkeypox: FAQs for men having sex with men

Read the latest information on Monkeypox for gay, bisexual, and men who have sex with men in Scotland.

What is Monkeypox?
Monkeypox is a viral infection. It is related to Smallpox but is not as severe. In the past, infections were seen in central or west Africa and only occasionally in the UK, usually in people who had travelled to Africa.

Why are the media reporting that it is passed on by Gay, Bi and other men who have sex with men (GBMSM)?
There have been a much larger number of infections than usual in the UK. Most but not all of these cases are in GBMSM who have no link to Africa.

What illness does it cause?
Monkeypox is usually a mild self-limiting illness that causes painful skin lesions, with a high temperature and fever. A blistering rash usually starts 1 to 5 days after other symptoms – the rash may start on the face or in the genital area and may spread to other parts of the body.

How is it spread?
Monkeypox is spread by contact with the blisters or ulcers and by respiratory droplets. It isn’t thought to be sexually transmitted, but it is passed on by any close contact, including during sex. So touching, hugging, kissing or sharing a bed without sex could pass on the infection. This means condoms do not offer protection against Monkeypox.

Coughing and sneezing when you have monkeypox can also pass on the infection to those close to you, as could sharing towels or handling the bedding of someone with Monkeypox.

So just how easy is it to pass on?
It is transmitted through close contact, especially skin to skin, including but not limited to sexual contact. E.g. Topless hugging etc. As sex usually also involves a lot of skin-to-skin contact this is one of the situations where the virus could transmitted.    

Why is it affecting GBMSM?
Whilst GBMSM are currently over-represented in cases this is not a virus that exclusively affects this population. It seems that the current cases are linked to GBMSM networks (socialising, apps, dating etc) mean that numbers are currently higher in this population.

How serious is it?
Monkeypox is usually a mild illness but can be fatal in some people. Most previous cases have been seen in Africa, where more people were susceptible to severe disease and treatments may be less effective. The current cases in GBMSM in the UK are a milder form or ‘clade’ of the virus. Whilst we’re still finding out more about this strain, it is thought that the fatality rate is likely to be less than 3% - possibly less than 1%.

Am I more at risk of serious disease if I get Monkeypox?
People who may be more at risk of serious disease include children, pregnant people and people who have low immunity (immunosuppressed).

Does it affect people with HIV differently?
We don’t know for certain how Monkeypox will affect people living with HIV, but the current advice is that treatment and care should be the same as for people who are HIV negative.

Most people living with HIV in the UK are on treatment and well. We think that the risk of severe illness might be greater for people with a CD4 count<200, a recent HIV related illness, or a viral load over 200 copies/mL. BHIVA has released a statement on HIV and Monkeypox.

Why all the fuss?
Monkeypox is currently categorised as a ‘High Consequence Infectious Disease’ – that’s the same category as something like Ebola virus, so this series of cases is being treated as a very high priority by governments, Public Health bodies and the medical community. So if a person believes they may have the virus, strict protocols will be followed to minimise the risk of transmission. Healthcare staff will use protective equipment (PPE) similar to that used for COVID-19.

Is a vaccine available?
Smallpox vaccine gives some protection against Monkeypox (Smallpox was eradicated from the world in 1980). Supplies of vaccine in the UK are currently limited. Some contacts of Monkeypox may be offered vaccine and it has been given to some healthcare staff who have cared for people with Monkeypox.

What should I do if I think I might have it?
Phone your local sexual health clinic if:
You have genital lesions (for example a blister or sore) and:

  • You think that you may have monkeypox
  • You've been in close contact with someone who might have monkeypox

If your sexual health clinic is closed, phone your GP. If your GP is closed, phone 111. In an emergency phone 999.

It is advised that until you are assessed you stay home and avoid close contact with others and that you make contact medical services by telephone.

For more information, visit Terrence Higgins Trust or NHS Inform.