People who have monkeypox can transmit it until their lesions clear. That means the lesions have completely healed — the scab has fallen off and there is healthy skin growing under that scab, Thomas said.

The good news is that while monkeypox is uncomfortable, it doesn’t appear to be deadly in the way that COVID-19 could be. But in rare cases, monkeypox lesions can inhibit breathing or swallowing, and lesions that affect the eye area can be more dangerous. In general, people who go to the hospital for their symptoms are there for pain management, according to Thomas.

About this virus

The monkeypox virus, part of the same family of viruses that causes smallpox, was discovered in 1958 in colonies of monkeys kept for research. Despite being named “monkeypox,” the source of the disease remains unknown, according to the CDC.

Vincent Guilamo-Ramos, RN

The first human cases of monkeypox appeared in 1970 and had been mostly restricted to central and western Africa, according to Vincent Guilamo-Ramos, PhD, MPH, LCSW, RN, ANP-BC, PMHNP-BC, FAAN, Dean and Professor of the Duke University School of Nursing, and Vice Chancellor for Nursing Affairs, Duke University. It was rarely seen outside Africa except for cases tied to those traveling internationally to endemic areas and being exposed to the virus, according to Ramos.

According to a CDC report, 99% of U.S. monkeypox cases occurred in men, 94% of whom reported recent male-to-male sexual or close intimate contact. As a result, public health efforts should prioritize gay, bisexual, and other men who have sex with men, for prevention and testing, as well as addressing equity and minimizing stigma, while maintaining vigilance for transmission in other populations, according to CDC.

Classic monkeypox presentations include blisters that look like pimples, which can spread across the body or as an atypical presentation of a single lesion on a particular body part, according to Ramos.

It’s important to note that lesions can be on the internal mucosa and may not be visible on the skin. Clinical exams might miss those.

Symptoms tend to last about two weeks. And most cases of monkeypox resolve on their own, Ramos said.

While there are no treatments approved specifically for monkeypox virus infections, antivirals developed for smallpox help treat monkeypox, according to the CDC.

One of the antivirals is tecovirimat, or TPOXX, but the U.S. government has an expanded access protocol for use of stockpiled tecovirimat to treat monkeypox during an outbreak.

Nurses can educate people about infection control by stressing hand washing, according to Ramos.

Those who are infected should avoid touching their eyes, he said. And if they live with other people in the home, they should consider isolating and covering their skin (including wearing a mask), when around others. Monkeypox can be transmitted to cats and dogs, so patients should also isolate from house pets, according to Ramos.

Addressing the stigma

The gay community experienced unfortunate stigmatization at the onset of the outbreak, according to Thomas, who said there are a few ways in which nurses can care for monkeypox patients with dignity and in a way that doesn’t stigmatize those with the virus.

The fact is that monkeypox can spread to anyone through close, personal, often skin-to-skin contact, including direct contact with monkeypox rash, scabs, or body fluids, according to the CDC. Transmission can also occur by touching objects, fabrics, and surfaces that have been used by someone with monkeypox, as well as through contact with respiratory secretions.

In fact, an August 19 Morbidity and Mortality Weekly Report by the CDC said surfaces contaminated with monkeypox were found in the home of two patients living in the same home and were referred to as “travel-associated cases of monkeypox.” Samples were collected for testing 20 days after the two patients had isolated at home.

Nurses caring for patients with monkeypox should ask questions that have purpose and avoid asking purely out of curiosity, according to Thomas.

Thomas said he understands the conundrum — the need to identify patients most at risk. But sometimes just doing that can be stigmatizing and can cause further inequities, Thomas said.

The assessment should be nonjudgmental, according to Ramos. “It’s about making sure that we’re not blaming; we’re not using language that is shameful; and that we’re inviting patients to open up and share their sexual health conversation with us,” Ramos said.

It can be an opportunity for nurses and patients to have conversations about safe sexual health practices, he continued. These conversations have to be realistic and without creating false dichotomies, Ramos said.

“Don’t have sex” isn’t a realistic message, but encouraging people to think about their risk is and then offering solution-based or pragmatic approaches about how they can reduce their risk of getting or transmitting the virus can be helpful, according to Ramos.

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