Digitally colorized electron microscopic (EM) image depicting an MPX virion (virus particle). Smith Collection/Gado/Getty Images
Digitally colorized electron microscopic (EM) image depicting an MPX virion (virus particle). (Smith Collection/Gado/Getty Images)

Mpox in the San Francisco Bay Area: What We Know About Symptoms, Cases and Spread

Mpox in the San Francisco Bay Area: What We Know About Symptoms, Cases and Spread

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Update, 12:20 p.m. October 20: The San Francisco Department of Public Health has announced it will end the city’s state of emergency around monkeypox (MPX) on October 31.

SF health officials said that MPX cases “have slowed to less than one case per day,” and that more than 27,000 city residents have now received the MPX vaccine.

San Francisco originally declared this public health emergency for MPX back in July, and was the first U.S. city to do so.

Original post:

A note: Several public health organizations, including the California Department of Public Health, have chosen to refer to monkeypox as “MPX” (pronounced “em-pox”) with the aim of reducing homophobic and racial stigma surrounding the virus. For the rest of this story, we use “MPX” for these reasons, except in direct quotes or other cases where it would confuse readers.

Back on August 4, the White House declared MPX a public health emergency. At the time of this announcement, there were more than 6,616 cases reported in the U.S.

As of Sept. 14, the CDC now reports 22,630 cases nationwide. And because of limited testing, this figure most likely still represents something of an undercount.

“We are prepared to take our response to the next level in addressing this virus and we urge every American to take monkeypox seriously,” Health and Human Services Secretary Xavier Becerra said. Read more about what the public health emergency means.

On August 1, Gov. Gavin Newsom declared a State of Emergency over the MPX outbreak in California. A week prior, San Francisco had declared its own state of emergency over MPX. State and local health officials have affirmed that cases are rapidly rising and have asked the federal government to make MPX vaccines more widely available.

Jump to a specific answer:

MPX has existed for decades — the first case among humans was registered in 1970 — but we’re now seeing multiple outbreaks across the U.S. See how many cases have now been reported nationwide according to the Centers for Disease Control and Prevention.

The majority of infections have been detected among gay and bisexual men, but public health experts have made it clear that MPX is an “equal opportunity disease,” meaning that anybody, regardless of sexual orientation, race, class or other demographic categories, is susceptible to infection.

However, public health organizations that serve the LGBTQ+ community in the Bay Area are still advising residents to learn more about MPX and how it spreads, particularly in the context of large public events in San Francisco celebrated by the queer community like Pride (the weekend of June 25), Dore Alley Weekend (the weekend of July 30) and Folsom Street Fair (the weekend of September 24) that take place in the summer and fall. San Francisco formally declared the outbreak a public health emergency back on July 28.

KQED spoke to physicians, public health officials and LGBTQ+ health groups to create this guide that includes the latest information on the disease, its transmission and available treatment, and what to do if you become infected. And if you’re looking for vaccine details specifically, you can read our full guide to where to find a MPX vaccine near you.

What is MPX?

MPX is a disease that is caused when a person is infected with the MPX virus. As the name might suggest, the virus is related to the smallpox virus but it’s generally less severe and “much less contagious” than smallpox, according to the California Department of Public Health (CDPH).

Although you might assume MPX is also related to chickenpox, it’s not.

How did MPX get its name?

The disease was called “monkeypox” because it was first found in 1958 in monkeys. The Centers for Disease Control and Prevention say that the first human case of MPX was recorded in 1970.

Several public health bodies, including the California Department of Public Health and the San Francisco Department of Public Health, have now chosen to refer to the virus as “MPX” to address concerns that the original name furthers both racist and homophobic stigma around the disease and those who contract it.

In speech, MPX is usually pronounced “em-pox,” or the initials “em-pee-ecks.”

You may often see “monkeypox” on first usage, and “MPX” thereafter throughout an article or a resource from a public agency. Some official resources may also use “MPOX”. Rest assured these names are referring to the same disease.

How dangerous is MPX?

While it’s less severe than smallpox, MPX can still be a serious disease. The good news is that according to the CDC, MPX is “rarely fatal” — and that “over 99% of people who get this form of the disease are likely to survive.”

However, “people with weakened immune systems, children under 8 years of age, people with a history of eczema, and people who are pregnant or breastfeeding may be more likely to get seriously ill or die.”

Being sick with MPX typically lasts 2-4 weeks. The symptoms of MPX are similar to smallpox symptoms, but luckily are milder.

How many MPX cases are in California and the Bay Area right now?

See the number of probable and confirmed MPX cases reported in California right now, via the California Department of Public Health.

See the current number of probable and confirmed cases of MPX in San Francisco, via the San Francisco Public Health Department.

See the number of nationwide MPX cases state-by-state, according to the CDC’s map.

A woman wearing a white lab coat and blue surgical gloves is photographed from behind over her left shoulder as she prepared a medical sample on a white table.
A nurse prepares a PCR test for MPX testing. (Carlos Lujan/Europa Press via Getty Images)

What are the symptoms of MPX?

According to the World Health Organization, the incubation period of MPX— that is, the amount of time between getting infected with MPX and actually developing the symptoms — is usually from six to 13 days. It can, however, range from five to 21 days.

The CDC says that you aren’t contagious during this incubation period.

After that initial incubation period, a person who’s infected with MPX will start to develop symptoms and become contagious to others. The CDC says that symptoms of MPX can include:

  • A rash (also known as lesions) 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 or anus. The rash goes through different stages before healing completely.
  • Fever
  • Headache
  • Muscle aches and backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion

Much like with COVID, symptoms can present quite differently in different people. According to the CDC, some people get a rash first, and other symptoms follow. Other folks will only experience the rash itself.

The symptoms of MPX that aren’t the rash — like chills, fatigue and headache — are similar to symptoms of COVID. This means it’s entirely possible you could initially mistake a MPX infection for a COVID infection (or you could assume it’s another illness entirely, if you then test for COVID and get a negative result). This is why watching out for a rash is really important.

The San Francisco Department of Public Health says that usually, that MPX rash will start in the form of red, flat spots, which then become bumps. The bumps then become filled with fluid, which will then break and crust over into a scab.

In addition to the itch they can cause, MPX lesions can be very painful, especially in genital areas or the anus. The CDC notes that people also can have permanent scarring after the rash.

The symptoms of MPX can last two to four weeks. This means that, with an incubation period that could be as short as five days or as long as 21 days, a person could be dealing with an MPX infection for anywhere from under three weeks to almost two months.

Who can get MPX?

Anyone can get MPX.

As more details emerge of the outbreak in the U.S., it appears that MPX infections are particularly affecting communities of gay and bisexual men, and men who have sex with men.

The World Health Organization notes that trans people and gender-diverse people “may also be more vulnerable in the context of the current outbreak.”

San Francisco Health Officer Susan Philip says that LGBTQ+ folks currently being at higher risk for MPX has “nothing to do with sexual orientation or gender identity,” but is more about “being part of these networks and having close contact within those networks.” People in these networks “will likely then have expanded eligibility, expanded access to [an MPX] vaccine,” she says.

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How does MPX spread?

According to the CDC, the MPX virus can spread from person to person in the following ways:

From contact with an infected person:
This could be direct contact with the infectious rash, scabs or body fluids, or during intimate physical contact, such as kissing, cuddling or sex. It could also spread via respiratory droplets during prolonged, face-to-face contact (even talking with someone at very close range).

The CDC says that right now, it’s “not known” if MPX can spread through semen or vaginal fluids.

From contact with an item that’s previously touched the rash or fluids of an infected person:
This could include touching or sharing clothes, bedsheets or towels. SFDPH notes that according to the CDC, studies show the MPX virus can live on surfaces for as long as 15 days and still infect someone — but that you’d need to touch that surface “for a pretty long time.”

You can get MPX from an infected animal, either through a scratch or bite, or by preparing or eating meat or products from an infected animal. Pregnant people also can spread the virus to their fetus.

How you cannot get MPX:
From casual conversations, or by passing someone with MPX (say, in a store) or briefly touching surfaces like doorknobs.

A seated couple holding hands. One person wears a dark plaid shirt, the other person wears dark blue jeans. Both of their faces are obscured.
Talking about health, and especially sexual health, is paramount. (Zackary Drucker/The Gender Spectrum Collection via Creative Commons)

How contagious is MPX?

The California Department of Public Health says that MPX is “far less contagious” than COVID.

You can be contagious with MPX — meaning you can spread the virus to another person — from the time your symptoms start until the time any scabs have fully dropped off and the rash has fully healed (i.e., until a fresh layer of skin has formed over them). The illness typically lasts 2-4 weeks.

Can you have — and spread — MPX without having symptoms (also known as being asymptomatic)? This is an area where what we know about MPX is still evolving.

The CDC’s current guidance says that people who don’t have MPX symptoms cannot spread the virus to others. But the World Health Organization also says “the extent to which asymptomatic infection may occur is unknown.”

Is MPX a sexually transmitted infection/disease (STI/STD)?

MPX is not strictly an STI.

MPX can spread through close, skin-to-skin contact and coming into contact with objects and fabrics used by somebody infected with MPX. This also includes coming into contact with the rashes and sores that can develop on an infected person’s skin and even inside their mouth. The virus can also spread through respiratory droplets and saliva.

This makes it possible for MPX to spread during sex and other intimate actions, like kissing and cuddling. But it can also spread through nonsexual behavior, like using a towel or bedsheets previously used by an infected person that have not been washed yet.

When someone tests positive for MPX, health officials will work with them to contact their close contacts, similar to the contact tracing method used for sexually transmitted infection, says Dr. Peter Chin-Hong, an infectious disease specialist at UCSF.

“That’s the highest priority for vaccines right now,” he says, “the contacts of people who are known cases.”

Chin-Hong also encourages sexual partners to talk about MPX before having sex.

“Whenever you have a new partner, you should have a very frank and open conversation that’s health-positive, and open-ended,” he explains. This can include things like possible HIV exposures and HIV test results, and asking about any potential MPX symptoms.

“‘Have you noticed any rash or anything like that recently or have you been in contact with anyone [with symptoms]?’,” he suggests as possible questions. “They are the people who are weighing the risks and benefits in different ways. So I think that … open and honest conversation is really important, not just to MPX, but just as a good practice in general.”

What should I do if I suspect I have MPX?

If you’re experiencing the symptoms of MPX, or you’ve been informed you could have been exposed to MPX, it’s important you take action as soon as possible. Here are the steps:

Contact a health care provider right away

If you have health insurance, reach out to your regular provider ASAP, or call your provider’s medical hotline if they have one.

If you don’t have health insurance, you should contact your county’s public health department to ask for their guidance:

The San Francisco Department of Public Health recommends that if you live in the city and you don’t have a provider, or have difficulty scheduling an appointment, you can be seen at SF City Clinic at 7th Street (628-217-6600) or at Strut at 470 Castro Street (415-581-1600).

Learn whether you can get tested for MPX

The test for MPX is a swab test, in which a swab is rubbed on your skin and then sent to a specialized laboratory.

The test results will take a few days, during which period you should isolate from other people and animals, and take steps to reduce the chances of spreading the disease yourself.

But right now, you may need to meet certain criteria to get a MPX test — San Francisco, for example, says that SF residents must have a rash or spots present to get a MPX test.

“Monkeypox is circulating here in our community,” says Tyler TerMeer, CEO of the San Francisco AIDS Foundation, but he stresses that testing isn’t available for everyone who wants it — yet. “This is different than some other viral infections,” says TerMeer. “You actually have to have an active lesion or rash that we can take a sample from in order to test to confirm whether it’s monkeypox or not.”

Find out whether you can get a MPX vaccine

A vaccine for MPX is being offered to people who may have been exposed to the virus, which is most effective given within the first four days of infection. Read our full guide to how to find a MPX vaccine near you. 

Contact anyone you’ve had close physical contact with

Ask health providers about formal contact tracing, but in the meantime, reach out by calling or texting anyone you’ve been physically close to since your symptoms started.

Do what you can to manage your symptoms 

The World Health Organization says that the symptoms of MPX, while often painful, normally get better on their own without the need for treatment — but that you should ultimately follow the advice of a health care provider. Jump to more information about what treatments are available for MPX.

The WHO says that medication for pain (analgesics) and fever (antipyretics) can be used to relieve some symptoms if needed, and that lidocaine can be applied to oral and perianal lesions to relieve pain. Talk to a health care provider about taking these kinds of medications.

The WHO also gives these tips for managing the symptoms of MPX at home:

  • Avoid scratching your skin.
  • Clean hands before and after touching lesions.
  • Keep your skin dry and uncovered.
  • Keep your rash clean with sterilized water or antiseptic.
  • If you have lesions on your body, take a warm bath with baking soda and Epsom salts.
  • Use saltwater rinses for lesions in your mouth.
  • Stay hydrated, eat well and get enough sleep.

Isolate yourself as much as possible

To avoid infecting other people, isolate yourself from others as much as possible. Avoid sharing your bedding, towels or clothing, as well as utensils and cups. Jump to more information about reducing the spread of MPX.

If you can’t avoid being in the same room as other people, the WHO advises you to keep your rash or lesions covered with clothing or a bandage. The organization also recommends keeping your own mental health in mind if you’re self-isolating, by staying connected to others using technology, and exercising if you feel well enough.

The right, blue-gloved hand of a medical technician holds a small vial, into which their other hand (offcamera) is dispensing liquid sample from a long white tool. The cap of the vial is bright green, and there are six vials in the background out of focus, with purple caps.
A medical laboratory technician inactivates suspected MPX samples to be PCR-tested in a microbiology laboratory. (Pablo Blazquez Dominguez/Getty Images)

What is the MPX vaccine, and how can I get it?

The MPX vaccine being offered in the United States right now is called Jynneos. This vaccine is also used to prevent smallpox.

The CDC recommends that the MPX vaccine be given to a person within four days of the date they were exposed to MPX, for the best chance of preventing onset of the disease.

If a person gets the vaccine between four and 14 days of being exposed, the vaccine may reduce the symptoms of MPX, but may not prevent the disease altogether. This timeliness is another reason it’s important to stay vigilant for possible exposure to MPX and watch for symptoms — and to act quickly.

Read our full guide to the MPX vaccine in the Bay Area.

What MPX treatments are available?

Currently, the drug Tecovirimat (also known as TPOXX or ST-246) is being used to treat those experiencing severe MPX. The Food and Drug Administration already has approved Tecovirimat to treat smallpox, and has recently expanded its use for MPX among adults and children.

Tecovirimat is usually a two-week treatment and can be administered either through a capsule or an intravenous (IV) injection. The drug works by making it harder for the virus to infect new cells, therefore limiting the infection growth.

“Most people will get better on their own but some people will require treatment,” says Chin-Hong of UCSF. Those considered for treatment include immunocompromised people, pregnant people and children under 8.

People who don’t have those particular risk factors but still develop severe MPX also can receive treatment, Chin-Hong says. This includes those who develop extensive oral disease, as that makes it very difficult to eat and drink. “It’s like having a bunch of ulcers in your mouth,” he says. Those who develop the disease extensively in the rectal area or near the eyes also can receive treatment.

The blisters and sores that develop can be quite painful, he adds: “Treatment is not only about vaccines and drug treatments but also about what specific symptoms the patient’s having.”

He recommends talking to your physician about what pain you’re feeling and where. If the disease is in the rectal area, it can be painful to defecate. But there are many options available that can alleviate, or at least reduce, the pain you may be feeling.

The MPX vaccine also can act as a sort of treatment, he says, but only when someone receives it shortly after being exposed. “In MPX, the incubation period is longer,” he explains. “So that means if you got a vaccine shortly after exposure — some people think within four days — it can impact and stop you from getting disease, even though you might have been exposed to an infection.”

“If you get the vaccine within 14 days of exposure, even though you might get the rash or disease, it will reduce your symptoms.”

A vial of the Jynneos MPX vaccine. (Bill O'Leary/The Washington Post via Getty Images)

Do we know how MPX interacts with COVID?

The California Department of Public Health stresses that MPX is “a completely different disease” from COVID, and that this outbreak is unrelated to COVID.

MPX is much less contagious than COVID and the way it spreads also is very different. SFDPH says this is “partly because people with MPX are generally thought to be contagious to people with whom they’ve had very close contact over a long period of time, and when they have symptoms like a rash.” COVID, on the other hand, spreads through the air and can be spread even when people do not have COVID symptoms.

However, UCSF’s Chin-Hong affirms that it’s completely possible to contract COVID-19 and MPX at the same time and adds that the impact that a double infection has on the body is still being studied.

How can folks protect themselves against contracting MPX?

The CDC says the following activities will increase your risk for being infected with MPX, and should be avoided to reduce the risk of infection:

  • Close, skin-to-skin contact with someone’s MPX rash
  • Touching the rash or scabs of someone with MPX
  • Kissing, hugging, cuddling or having sex with someone who has MPX
  • Sharing eating utensils or cups
  • Handling or touch the bedding, towels or clothing of someone with MPX

Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially after contact with people who’ve been infected with MPX. Read the CDC’s guide to disinfecting spaces to prevent the spread of MPX.

Additionally, the San Francisco Department of Public Health advises you cover exposed skin in crowded settings (whether that’s indoors, like in a bar, or outdoors at a festival or a parade).

They also recommend you don’t share bedding or clothing with others generally, even if you aren’t sure if they have MPX, and talk to your close physical and sexual contacts about their health generally, including whether they’re seeing recent rashes or sores on their body.

What are health officials doing to prevent and combat stigma about MPX?

San Francisco AIDS Foundation CEO TerMeer says that vaccine equity is also very much on the minds of advocates right now, “ensuring that we don’t repeat any mistakes of the past so that communities of color or other communities that have traditionally been furthest from access and opportunity in the health care space don’t get left out of the conversation.”

“Our predominant advocacy at the moment is just ‘we need vaccines and we need them now,’” says TerMeer. “We are really pushing to try and get at least 1,000 doses of vaccine in the next 30 days so that we can get ahead of the issue and are really hoping to be able to respond effectively, before it grows into a larger issue.”

If you are looking for additional health advice on MPX, you also can access:

This post includes reporting by KQED’s Vanessa Rancaño, Juan Carlos Lara and Matthew Green. A version of this story was published on July 8.

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