Signs and Symptoms of Monkeypox: What the Rash Looks Like and What to Watch for

In Illinois, more than 850 cases of the virus had been reported as of Tuesday morning, according to the Illinois Department of Public Health

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With monkeypox cases continuing to spread in the Chicago area and across Illinois, sparking emergency declarations, many may be wondering which signs and symptoms they should watch for and what a potential rash might look like.

Since May, nearly 90 countries have reported more than 31,000 cases of monkeypox.

The World Health Organization classified the escalating outbreak of the once-rare disease as an international emergency in July; the U.S. declared it a national emergency earlier this month, just after Illinois declared a public health emergency over the virus.

In Illinois, more than 850 cases of the virus were reported as of Tuesday morning, according to the Illinois Department of Public Health.

So what should you be watching for?

Symptoms of Monkeypox

Experts warned that most people who contract monkeypox experience flu-like symptoms before developing a rash, though some may develop a rash first followed by other symptoms, or no other symptoms at all.

Still, according to the Centers for Disease Control and Prevention, "most people with monkeypox will get a rash."

The flu-like symptoms may include fever, headache, muscle aches and backache, sore throat, cough, swollen lymph nodes, chills or exhaustion.

"Suspected cases may present with early flu-like symptoms and progress to lesions that may begin on one site on the body and spread to other parts," CDPH previously stated.

Health experts also stated the illness can be confused with a sexually transmitted infection like syphilis or herpes, or with varicella zoster virus.

What Does a Monkeypox Rash Look Like?

Chicago's top doctor said the rashes "can look like a blister, like a pimple and can be very painful."

"These sores can look like pimples and may be painful or itchy. They can be inside the body, including mouth, anus or vagina," the Illinois Department of Public Health states.

Photo credit: UK Health Security Agency as displayed on CDC’s website

Dr. Irfan Hafiz, an infectious disease specialist with Northwestern Medicine’s McHenry and Huntley hospitals, said the virus causes symptoms that are similar to several maladies, including chickenpox or smallpox.

“It can, to the layperson, look like chickenpox or warts,” Hafiz said. “But these (sores) tend to be in exposed areas.”

When Do Symptoms Start?

Typically, symptoms start within three weeks of exposure to the virus, health officials said, with most infections lasting between two and four weeks.

According to Illinois' health department, the incubation period for monkeypox is usually 7 to 14 days but can range from 5 to 21 days.

"Anyone with a new or unexplained rash or a rash that looks like monkeypox should talk with their healthcare provider, even if they don’t think they had contact with someone who has monkeypox," DuPage County health officials said in a statement. "Avoid close contact (including intimate physical contact) with others until a healthcare provider examines you."

How Does Monkeypox Spread?

In Africa, monkeypox mainly spreads to people by infected wild animals like rodents in limited outbreaks that typically have not crossed borders. In Europe, North America and elsewhere, however, monkeypox is spreading among people with no links to animals or recent travel to Africa.

The WHO’s top monkeypox expert, Dr. Rosamund Lewis, said last week that 99% of all the monkeypox cases beyond Africa were in men and that of those, 98% involved men who have sex with men. Experts suspect the monkeypox outbreaks in Europe and North America were spread via sex at two raves in Belgium and Spain.

Person-to-person transmission is possible through "close physical contact with monkeypox sores, items that have been contaminated with fluids or sores (clothing, bedding, etc.), or through respiratory droplets following prolonged face-to-face contact," according to the Chicago Department of Public Health.

"Based on everything we know now, monkeypox is not spread through casual conversations, or by walking by someone with monkeypox like you might in a grocery store," Arwady said. "It is not as contagious as influenza or COVID. You don't become infected by just being around infected persons unless you have prolonged close contact or share bedding or clothing, for example, with someone who has MPV."

According to Dr. Sharon Welbel, director of hospital epidemiology and infection control at Cook County Health, the virus does not typically spread simply from "bumping up against somebody."

“The way it typically seems to happen is that there is a lesion and it bursts or it's opened up and it gets into a scratch or something one can’t even see but a crack in the skin," she said. "It is not by bumping up against somebody, being in the same room as somebody, sharing a seat with somebody.”

She noted that it "generally takes prolonged contact."

Experts have cautioned that there is no current evidence to suggest the virus is airborne.

Dr. Amu Hazra, an infectious disease physician with Howard Brown Health, said that while a majority of cases have been in men who have sex with men, "the virus doesn't care how you identify."

Two children have been diagnosed with monkeypox in the U.S., health officials said. In addition to the two pediatric cases, health officials said last week they were aware of at least eight women among the more than 2,800 U.S. cases reported so far.

What is the Treatment for Monkeypox?

With supplies limited, health officials are not recommending mass vaccination. They are suggesting the shots for health workers, people who have been in close contact with an infected person, and men at high risk of catching monkeypox.

Officials are also trying to stretch supplies of the vaccine, Jynneos. It requires two doses, but many places are only giving one dose.

U.S. health officials on Tuesday authorized a new strategy that would allow health professionals to vaccinate up to five people — instead of one — with each vial. The approach uses just a fraction of the typical amount of vaccine and administers it with an injection just under the skin rather than into deeper tissue. Recipients would still get two shots a month apart.

Officials said the new approach allows them to make hundreds of thousands more doses available while they gather data about how the shots are being used. That will help the government make sure doses are being administered to the places and people that need them most, officials said.

U.S. officials previously shipped more than 630,000 doses, though not all have been used.

Federal health officials have suggested they would need about 3.2 million shots to vaccinate all those considered at highest risk of monkeypox.

What's the Difference Between Monkeypox and Smallpox?

The main difference between smallpox and monkeypox is that monkeypox causes lymph nodes to swell while smallpox does not, according to IDPH.

NBC Chicago/Associated Press
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