MonkeyPox Wellness guide

This is a live document. Last update August 28th.

Disclaimer: The information below was not compiled by medical professionals and is only intended as a quick-guide based on other people’s experience and understanding. It was created to complement a WhatsApp support group. Wherever possible, please talk to your healthcare provider and learn more about monkeypox from the CDC website, which has a wealth of information.

Symptoms and their management:

* Fever (take Advil, Tylenol)

* Headache (take Advil, Tylenol)

* Muscle aches and backache (take Advil, Tylenol)

* Swollen lymph nodes (neck or groin)

* Chills (usually preceding the fever going up)

* Exhaustion (usually one of the very first symptoms)

* A rash that can look like pimples or blisters that appears on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals (usually the shaft or base of the penis, scrotum) or in anus.

* Itchiness: Blot with calamine lotion throughout the day. This will also help the lesions shrink and dry up faster. Avoid formulations containing alcohol which can cause irritation and delay healing.

* Anorectal pain. Many have reported extreme pain in the anus/rectum due to the lesions and this is the worst symptom. These are the best tips for this excruciating pain also updated here on July 16. A rectal STI check/swab is also suggested to rule out/treat any concurrent bacterial infections/superinfection.

  1. 300mg up to 3x a day Neurontin/Gabapentin (may make you lethargic; many report superior pain control; yet balance the benefit vs. side effect in accordance to your pain)
  2. Sitz bath. Plastic tub to soak the ass and anus in salt or epsom salt and luke-warm water. Then pat dry or air dry with a fan.
  3. Oxycodone/acetaminophen (Rx. Brand and Other Names:Percocet, etc). 1 or 2 if needed. Combine with stool softener as it can cause constipation and hard feces that are painful to pass.
  4. Lidocaine max strength (e,g, Aspercreme) or Rx strength, on and inside the anus. Avoid formulations containing alcohol which can cause irritation and delay healing.
  5. Many are also reporting great relief with THC (smoked or edibles).

In more rare cases, rectal pain may be accompanied by proctitis and bleeding as the condition evolves. Some have experienced passing what looks like mucus or pus and the bleeding starting slow and increasing to severe bleeding through the anus, which tapers off over a few days. If bleeding is severe, seek emergency care.

* Penis/urethral pain when urinating (likely caused by lesions in your urethra). May observed some bleeding as well. Pain control with Pyridium 200mh 3x a day by mouth. It will stain your pee orange. Don't panic and protect your underwear.

*Lesions in the mouth/throat. They look like white splotches and should be tested for coinfection with strep. You may see some pictures here in Figure 2b. We are not aware of anything specific for pain management. Drink warm soothing liquids and keep a mostly liquid diet if swallowing is painful.

The illness typically lasts 2-4 weeks. Sometimes, people get a rash/lesions first, followed (or preceded) by other symptoms. Others only experience a rash.

Testing:

Testing can only be performed by swabbing lesions. If you have no rash, bumps or lesions testing is not possible. Testing is performed by your PCP (Primary Care Physician) or other care provider and is intended to collect Virus DNA for PCR testing which is now available by many commercial labs like LabCorp and Quest. Test results are taking a few days but this may evolve quickly as more testing capacity is added.

Treatment:

Some confirmed positives have been treated with a 14 day course of an antiviral called TPOXX or Tecovirimat. Here is a comprehensive user-generated resource on TPOXX and how to get it. One dose of 3 pills every 12 hours. TPOXX doses are to be taken with a meal containing at least 24 grams of fat, presumably for successful absorption. The medication may not be readily available and is sometimes being increasingly restricted to more severe cases and the immunocompromised. Its degree of efficacy remains unclear and you will have to sign a waiver/consent, called an IND to receive it.

Vaccine (PrEP or preventative vaccination) and Post Exposure Prophylaxis (PEP):

JYNNEOS is licensed by the FDA as a vaccine for PEP monkeypox and is available in limited supply. For individuals that have been exposed to monkeypox, it can be given as PEP to reduce the risk of disease or make the symptoms milder. Please note that older generations vaccinated for smallpox (smooth scar on your upper arm) may have some protection but because many are still catching monkeypox a new vaccination is highly recommended.

After CDC approval vaccines are being given intradermally at a smaller dose relative to the larger dose needed in the triceps muscle. Redness, swelling and itchiness for 1-2 weeks is normal,

Vaccine are becoming more widely available, at least for the first dose.  Second doses after 28 days or a bit longer are also being distributed across the US and other countries.:

Important preliminary data on the efficacy and time to protection after starting the 2-shot vaccination course. Please share with folks who are being vaccinated and are trying to prevent MPX.

7-14 days after first shot: 29% efficacy (pretty low); 28 days 83% (HIV-) and 67% (HIV+). 42 days (2 weeks after second shot). 98% (HIV-) and 96% (HIV+)

Typical rash or lesions.

They usually show a dimple (umbilication). More pictures of lesion evolution are  here on CDC website. These images show how they evolve over time. Ask/share on the Whatsapp support group (you may join “Monkey business” here) for other photos if you need help identifying your lesions.

Many are experiencing new lesions appearing well into day 10 from symptoms onset and beyond. This is normal. These new lesions tend to be smaller, isolated, usually on torso or limbs and seem to evolve fast and resolve quickly, typically at a similar time as the ones anal/ genital ones that preceded them.

How to take care of your rash or lesions throughout their evolution:

  1. As the lesions form and develop, try to keep them dry (including in moist areas like penis and external part of the anus) to expedite their natural evolution. You may use calamine lotion which helps with itchiness and helps drying them. Keep doing this until the first scab falls off. Do not touch or pick the scabs, this will help spread the lesions and also may cause scarring. Always wash your hands with soap after touching your lesions, like after you apply calamine. Avoid formulations containing alcohol which can cause irritation and delay healing.
  2. After the scab falls off (typically in the shower), many are experiencing that the site is still weepy and raw. It frequently will go through a rescabbing, with a thinner, lighter scab. At this stage to prevent scarring it is suggested to apply Aquafor ointment and keep the lesion wet.
  3. After all scabs have fallen off and the new skin is smooth and has the same texture as the surrounding skin, you may use an anti scarring agent. An aesthetic medicine practitioner I trust suggested Silagen scar gel. You may also buy online here & here. Other medical-grade silicone gels are available.

Sexual Health:

Monkeypox can be spread from the time symptoms start until the rash has healed. Avoid sex or closeskin comtact with anyone until the rash has healed, scabs have fallen off and you have a fresh layer of skin. This can take 2-4 weeks.

Wearing condoms 12 weeks after all lesions have healed with new skin is recommended as new research has found that Monkeypox virus is present in semen after lesions have healed.

Suggested disinfectants - Household items (not for your body):

  • Lysol disinfectant spray (surfaces, high touch objects, clothing and linens and if safe upholstery)
  • Disinfectant wipes
  • Bleach-containing spray cleaners
  • Hydrogen Peroxide
  • Rubbing alcohol
  • Apple Cider Vinegar for its antiviral and antibacterial properties.

Best wellness practices:

  1. Wash your hands frequently with soap especially after touching your lesions, like when you apply calamine or other meds. Try avoiding touching lesions and other parts of your body that are not infected. Do not pick or lance lesions to minimize risk of spreading infection and scarring.
  2. We recommend alternating your towel every other day. White towels are best so you can bleach them. Consider spraying your sheets with Lysol disinfecting spray especially if you see scab fragments or stains from oozing lesions.
  3. Risk of infecting pets like dogs or cats with monkeypox is likely. These animals can be infected with related orthopox viruses. And there is new evidence of human to dog household transmission . It is suggested you isolate yourself from pets. Further info on pets from CDC.

Look for For more information please visit the CDC website: https://www.cdc.gov/poxvirus/monkeypox/index.html

Good scientific paper about the recent outbreak from the New England Journal of Medicine. Tons of great data in here!

Public link to this document:

Monkeypox Wellness Guide  easy to memorize and share link→  bit.ly/MPX-wellness

Invite link to the WhatsApp group “Monkey business”: this is a support group for asking questions and sharing photos & tips. About 40 participants as of August 16.

Zoom support group facilitated by Jeffrey Galaise. On instagram @Jeffervescense 

Tuesday and Thursday 6 PM EST

https://us02web.zoom.us/j/81612480770?pwd=eVNJV25RMUtNd01LU0N6SG1aWDVBdz09

Meeting ID: 816 1248 0770

Passcode: message Jeffervescense on IG or email j.galaise@gmail.com

For feedback and suggestions you may email: ale.rugge@gmail.com Subject line: ”wellness guide”.