In August 2022, we interviewed two virologist experts to better understand the rising threat of monkeypox. This article contains some of their answers to questions that our producers and SciFri listeners asked about how the virus spreads, accessing tests and vaccines, and the stigma associated with the virus.

Dr. Rachel Roper is a virologist and professor of microbiology and immunology at Brody Medical School at East Carolina University. Dr. Perry Halkitis, PhD, is the Dean of the Rutgers University School of Public Health.

These answers have been edited for brevity and clarity.

How does monkeypox spread?

Dr. Rachel Roper: Monkeypox can spread through the respiratory route if you’re very close to someone, but it’s much less contagious than COVID. You’re not going to catch it through the air like you would catch COVID. But the way that this variant is spreading is through close personal contact, skin-to-skin contact.

Can you catch monkeypox from touching a surface or clothing that someone else has touched?

Dr. Rachel Roper: That’s a place where monkeypox is actually more of a problem than COVID would be. With monkeypox, the pox viruses have very stable virus particles, so it can spread more easily on surfaces just because it’s more stable.

If you go to the CDC website, you can look for how to disinfect clothing and surfaces. It could potentially spread that way. It’s not likely. It’s much less contagious than COVID. But if you’re out somewhere, and you touch a doorknob that someone just touched and they’ve got monkeypox, you could get it on your hand. Then if you touched your eyes or your face, it could get into your body.

It’s always a good idea, if you’ve been out in the public somewhere, don’t touch your face while you’re out in public and especially if you’re touching things. Then when you get home, wash your hands with soap and water.

What are the monkeypox symptoms to look for?

Dr. Rachel Roper: The thing that I worry about is that the first symptoms can be just like many illnesses. You can get fever, chills, be tired, have muscle aches, backache, or respiratory symptoms like sore throat and nasal congestion. Those can be the first symptoms. The person might not get a rash until four days later. So, they might have monkeypox for four days and not know it. With monkeypox, people could get it and end up transmitting it before they realize that they have it.

Where do monkeypox lesions show up on the body?

Dr. Rachel Roper: You do more frequently get lesions on the skin of the face and genitals, just because it’s thinner skin and it’s easier to create lesions there. But certainly, the sexual contact, that’s probably some localized lesion to lesion spread. But then people can get it on their hands and feet. The hands are especially a problem because people walk around touching things with their hands, and they could be leaving the virus on surfaces. They get lesions in the mouth, too.

Is there a test for monkeypox like we have for COVID? Why aren’t more tests available?

Dr. Rachel Roper: My lab can easily test for the monkeypox virus genome or for the proteins. It’s really easy to do. The thing that makes it more difficult is that diagnostic labs have to be certified as properly testing. So they have to test that they get a certain very low number of false positives and a very low number of false negatives with a large sample of human population.

So that’s a much higher standard than just being able to detect it in a research laboratory. That’s why it’s different. But the CDC has been working with these CLIA-certified labs to get them up, running, and testing so that we can test more samples at a higher rate. And I think that is important because you can’t find something if you’re not watching for it. And there could be rashes showing up in dermatologists’ offices or in gynecologists’ or general health practitioners’ offices that we really probably should test.

What’s the difference between the monkeypox vaccine and the smallpox vaccine?

Dr. Rachel Roper: The smallpox vaccine is the monkeypox vaccine. Smallpox, monkeypox, and vaccinia virus, which is what the vaccine strain is. They are all in the same genus. They’re closely related viruses. So the government and the scientific community has focused on smallpox for the last 30 years because that’s really what we’ve been concerned about. So all of these vaccines and drugs were designed for smallpox, but they also work for monkeypox, and that’s our current problem. That’s why those vaccines and drugs are being used for monkeypox now.

If I got the smallpox vaccine when I was a kid, do I still have immunity?

Dr. Rachel Roper: Yes, you probably do have some residual immunity, but immunity wanes over time. So the older you get, the less strong your immune response is. The longer ago that you had the vaccine, the less likely you are to have strong protection from it. 

Should we be concerned about monkeypox mutating and adapting like COVID-19 has?

Dr. Rachel Roper: One good thing is that pox viruses are large double-stranded DNA genomes. Those mutate much more slowly than an RNA virus like SARS-CoV-2. The mutation rate should be much lower.

But a paper did come out recently showing there were 50 single mutations that have occurred already in the last few years. And that’s probably because monkeypox is adapting more to spread human to human, so it can mutate. It almost certainly will mutate, but it should have a mutation rate much, much slower than COVID-19.

Monkeypox can spread during sex, but it’s not a sexually transmitted infection. How has this framing of monkeypox as an STI impacted the public’s understanding of the virus and how policymakers dole out resources needed to contain the outbreak?

Dr. Perry Halkitis: When we say sex, we don’t necessarily mean intercourse. People can be engaged in intimate relations with each other, they can be rolling around with each other; there doesn’t have to be an act of intercourse for monkeypox to spread.

And so it is not an STI per se, as we might think of syphilis, gonorrhea, or chlamydia. You can be in bed with an individual. You can be kissing that individual. You can be hugging that individual. If that person has an infection, you may become infected.

The bottom line here is anybody can get monkeypox. However, it is primarily in gay and bisexual men right now who have intimate relations with each other. So our policies in some ways have been shaped by the past, and a fear of making a mistake right now in the present.

When you make a disease, and you call it an STI, when you overemphasize sex, and you make it about gay sex, which is stigmatized to begin with… In the hands of wrong people, like politicians who are seeking to do harm, it’s potentially a lethal weapon that will stigmatize the population affected and ultimately deny, in this case, gay and bisexual men, the resources that they need in order to combat this virus.