Let’s Talk Pox

Infectious diseases are a part of life. But, knowing how to respond isn’t always easy. For many gay, bisexual, and queer men—including Two-Spirit, trans, and gender diverse people (2S/GBTQ+)— outbreaks of mpox, or monkeypox, have meant uncertainties: How can we protect ourselves and our communities? What steps should we take if we test positive? How can we respond to fear and stigma linked to mpox?

While anyone can get mpox, recent outbreaks are mostly impacting 2S/GBTQ+ people. The outcomes can sometimes be severe. The good news is our communities have tremendous experience rallying in response to infectious diseases and STIs. This site exists to share information about mpox—what we know, what we don’t, and how you can care for yourself and each other.

What is mpox?

Mpox (monkeypox) is a virus that can cause fever, muscle pains, and a rash that develops into blisters. It’s no walk in the park! Mpox generally goes away on its own, but symptoms can last for several weeks, during which it is still possible to pass on the virus. Mpox is related to smallpox, but the symptoms are less severe.

It’s exceedingly rare to die from mpox based on what we’re seeing in recent outbreaks, but hospitalization is sometimes required. Getting mpox also means weeks of self-isolation in order to prevent the spread of the virus, and many people experience intense pain.

How is mpox transmitted?

Mpox seems to be most commonly spread through skin-to-skin contact during sex, including oral and anal sex. It can also be passed on during other types of close physical contact or exposure to contaminated surfaces or bedding.

  • Close contact: Mpox can be transmitted through skin-to-skin contact with the scabs or blisters of someone who is infectious. It can also be transmitted through respiratory droplets.
  • Clothing or bedding: Clothing, bedding, and towels used by someone who is infectious can transmit the virus. Washing this laundry at home is effective for cleaning.
  • Surfaces: The virus may be able to spread by surfaces used by someone who is infectious, and should be sanitized if there is any risk of contact.
  • Bodily fluids: We are still learning to what extent bodily fluids, including semen, can transmit the virus. Mpox DNA has been found in semen, but it is not totally clear if semen is likely to contain an active, intact form of the virus that could cause infection.

So is mpox an STI? While mpox can be transmitted though close contact, including sex, it can also be passed on through non-sexual contact. What’s clear is that the virus is being passed on through 2S/GBTQ+ sexual networks. This means that, based on current trends, you’re much more likely to be exposed to mpox if you are sexually active.

How can I protect myself and others?

Getting vaccinated

Getting vaccinated reduces the chances of mpox infection and can prevent serious illness. Vaccines against mpox are now available for 2S/GBTQ+ people in several provinces and territories. See our resource page for information about the vaccine and where to access it.

Learn more about the mpox vaccine

Communicating with partners

Communicating with your sexual partners can also help stop the spread of the virus. It’s fairly simple, but exchanging contact information with people you sleep with can help keep each other safe. If one of you tests positive for mpox, it will be easier for your local public health authority to engage in contact tracing. This can help to identify mpox cases sooner, and enable easier access to testing, vaccination, and other support.

Communicating with partners

Communicating with your sexual partners can also help stop the spread of the virus. It’s fairly simple, but exchanging contact information with people you sleep with can help keep each other safe. If one of you tests positive for mpox, it will be easier for your local public health authority to engage in contact tracing. This can help to identify mpox cases sooner, and enable easier access to testing, vaccination, and other support.

Taking additional steps to reduce transmission

We all navigate sex and risk in our own way. If you’re thinking of taking additional steps to reduce the spread of mpox, you have some options. For example, during the COVID-19 pandemic, some 2S/GBTQ+ people reduced their number of sexual partners, chose to sext or cam more often, or formed “sex bubbles”, limiting their sexual partners within a closed group. These strategies would also work to reduce exposure to mpox.

Because mpox can be transmitted in various ways, including through respiratory droplets, the skin, and possibly bodily fluids, barriers like masks and condoms aren’t a surefire way to prevent transmission. That said, it’s possible these barriers offer some level of protection from mpox, and—in any case—help prevent other infections.

Symptoms and getting tested—How do I know if I have mpox?

Mpox symptoms can show up between 5 and 21 days after exposure to the virus, but most often show up between 6 and 13 days after exposure. If you think you might have mpox, review the symptoms, which can include fever, muscle pains, and a rash that develops into blisters. Many people experience fever/chills before they notice any rash. If you have symptoms consistent with mpox, contact your health-care provider or local public health authority to get tested. Limit contact with others.

When it comes to getting tested, you may want to reach out directly to a health care worker you know and trust. Not all health care workers are knowledgeable about mpox, or about issues impacting 2S/GBTQ+ people. If you’re at a loss on who to reach out to, your local public health authority should be able to connect you with local resources. You may also experience difficulty accessing testing if you don’t have pocks (sores or blisters). Check out our resource page to learn more about self-advocacy relating to testing and other mpox supports.

Learn about self-advocacy and mpox supports

While mpox usually resolves on its own eventually, getting tested will confirm whether you need to isolate, and provide important information to the health care system on the spread of the virus.

I have a confirmed or suspected case of mpox. What should I do?

If you have mpox, you aren’t alone. Infectious diseases are a part of life, but unfortunately they can also lead to feelings of shame and marginalization. As the virus continues to impact GBT2Q communities, there is a growing stigma relating to mpox, and those who are getting it. Check out our resource page or visit igotmpox.com to read first-hand accounts from people who’ve experienced mpox, and advice about navigating stigma related to mpox.

Hear from people who’ve had mpox

Vaccination—If you’ve already been exposed to mpox, getting vaccinated can still help your immune system fight the virus. Contact your health care provider or local public health authority to ask about post-exposure prophylaxis (PEP) for mpox. Getting the vaccine is recommended as soon as possible after exposure to mpox, but can be provided up to two weeks after exposure.

Isolation—Recovering from mpox requires self-isolation, which can last three weeks or longer. For many, this can be a big challenge. But wherever possible, follow isolation guidance from your public health authority. The pocks (sores or blisters), continue to be infectious until the scab falls off and there is new skin underneath.

If you are isolating, consider reaching out to your support network. If you aren’t in isolation but know someone who is, consider reaching out to them and offering to deliver supplies if you’re able.Wound care—Effective wound care can help in managing pain and discomfort from mpox, but many people with mpox aren’t given proper guidance from the health-care system. Learn more about wound care for mpox on the resource page.

Learn more about wound care

Seeking medical treatment—Mpox usually resolves on its own within three to four weeks. But, for many, mpox causes significant pain and discomfort, and it may be important to receive medical attention during this time. When it comes to pain, try talking to your health care provider if over-the-counter painkillers aren’t cutting it.

If you have pocks in/near your eyes, in your throat (affecting your ability to breathe) or rectum (with intense pain), you should seek medical attention to prevent any long term damage.

In addition to getting tested for mpox, it is important to seek medical care if there are signs of a secondary bacterial infection. It’s possible for pocks (sores or blisters) caused by mpox anywhere on your body to get infected. Avoid scratching the area to reduce the chance of infection. Some signs that your pocks are infected include extra redness in the surrounding area, swelling, and increasing or intense pain, white discharge, and having a fever.

What is Tecovirimat (Tpoxx)?

Tecovirimat (also known as Tpoxx) is an antiviral drug designed to treat smallpox. In some contexts, tecovirimat is also being prescribed to treat mpox, however this form of treatment is considered “off-label” and there isn’t strong evidence to support it at this stage. More research will help determine whether tecovirimat is an appropriate treatment for mpox.

I am living with HIV. Are there particular precautions I should take?

For people living with HIV, current guidance doesn’t indicate additional measures necessary to prevent mpox infection. However, all people who are immunocompromised—including those living with HIV who are not receiving regular antiretroviral treatment or have a CD4 below 200—may have a higher likelihood of severe illness if they are exposed to mpox. The vaccine currently offered in Canada (Imvamune) is shown to be safe for people living with HIV.

Why is mpox impacting 2S/GBTQ+ people specifically?

Research is ongoing to understand trends in recent mpox transmission. While it’s clear mpox is spreading within 2S/GBTQ+ men’s social and sexual networks, the reason 2S/GBTQ+ people are most impacted is less clear.

One explanation is that 2S/GBTQ+ people tend to have different sexual patterns than other groups. 2S/GBTQ+ people often have a higher number of sexual partners, for example, and non-monogamous relationships are more common. This may mean the mpox virus can spread more easily in a “chain” from person to person. While many non-2S/GBTQ+ people also have a high number of sexual partners, different patterns of sex and intimacy in the population could mean the virus doesn’t spread efficiently enough to survive. This aligns with one mpox modelling study from the UK, which used data about sexual patterns to predict mpox transmission.

Let’s talk vaccination!

Vaccination against mpox is currently available in many regions across Canada. Follow the links below, or contact your local public health agency to find vaccine clinics in your area.

Currently, vaccines against mpox are not widely available in the regions below. However, you may still be able to access the vaccine if you are a close contact of someone who is infectious.

  • Northwest Territories
  • Prince Edward Island
  • Yukon

What is Canada’s current approach on mpox vaccination?

Canada’s current approach is to offer only one dose of the vaccine given a limited supply. But, having two doses offers the most protection. Eligibility for the mpox vaccine varies by region, but 2S/GBTQ+ people—particularly folks with multiple sexual partners—are being prioritized in most areas.

Tell the Government of Canada we need more vaccine

What do we know about the effectiveness of the vaccine?

Initial studies suggest vaccination is about 85% effective in preventing mpox, but more research is needed to understand vaccination as a factor in current mpox outbreaks. This initial evidence comes mostly from data collected in the 80s, and some important questions remain. For example, we don’t know exactly how effective single doses are compared to two doses. Also, we aren’t sure whether the effectiveness of the vaccine depends on the strain of mpox currently circulating.

One thing we’re sure of is that the vaccine is safe. The vaccine teaches your immune system to fight mpox and it takes about 2 weeks for the vaccine to be fully effective.Not sure if you’ve been vaccinated?

Many people don’t know if they’ve been vaccinated against mpox. If you are under 50, you did not receive the vaccine as part of Canada’s smallpox/mpox vaccination program. Vaccines effective against smallpox and mpox were previously offered to everyone in Canada, but this program ended in 1972.

Not a fan of needles?

If you have a hard time with needles, you may find the vaccines against mpox easier to manage than other vaccines. The vaccine currently available in Canada (Imvamune) is given differently than many other vaccines. Because it is given in the fatty layer beneath the skin, instead of into muscle, many people find it less painful.

Let’s talk wound care!

Let’s talk self-advocacy!

Write a letter to the Minister of Health and your MP

Dear _______,

A monkeypox diagnosis can mean excruciating pain, weeks of isolation, and unpaid time off work. Yet, months into the epidemic, little support exists in Canada for those impacted.

It’s time the government does more to address monkeypox.

Continued outbreaks are worsening inequities for gay, bisexual, and queer men—including trans, and Two Spirit people—(2S/GBTQ+) who are overrepresented among monkeypox cases. For many, following self-isolation guidance will mean not being able to pay for rent, food, or medications. Many others are left without access to a full course of vaccine, which is fundamental in reducing transmission and harms from the disease. As we learned from COVID-19, an effective public health response requires dedicated resources and support for those impacted.

I urge the Government of Canada to:

  1. Provide financial support for people who need to self-isolate following confirmed or suspected monkeypox infection. This should include direct financial assistance, and a waiver of the one-week waiting period for Employment Insurance benefits.
  2. Increase the supply of monkeypox vaccine for provincial and territorial distribution to allow a full course of vaccine to be provided to 2S/GBTQ+ people.
  3. Engage provincial and territorial health systems to improve post-diagnostic support for people with monkeypox. This should include guidance around pain management and wound care, and information on the use of Tecovirimat as treatment for monkeypox.

Sincerely, (Your name goes here)

As mpox outbreaks continue, so do research and advocacy efforts that seek to respond. Keep up to date with the latest mpox news below.

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