MPX (monkeypox) General

As of Sept. 26, 2022, there are no confirmed cases of MPX (monkeypox) in Missoula County, however, it is possible that the virus could be circulating without yet being identified. MPX can present similar to herpes, syphilis, and other illnesses that cause sores. If you have recently experienced an unexplained rash please get assessed by your primary care physician. 

MPX is actively spreading in the men who have sex with men (MSM) population nationwide. While it is not exclusively spreading in this population, and anyone is capable of getting MPX community may want to take extra precautions to avoid contracting the virus.

MPX is a virus within the family of orthopox viruses, which also includes smallpox, cowpox and other viruses. MPX infections are rare and until recently were typically only reported in West or Central Africa where the disease is endemic. In May of 2022, MPX began spreading in nonendemic regions of the world with cases first reported in Europe.

Images of MPX

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MPX can present in different ways. Some lesions are large and others are small. Some patients have mistaken the lesions for pimples or ingrown hairs. If you are suspicious of any new or recent rashes it is best to get tested by your physician.

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In these images you can see the progression of the lesions. The lesions will scab over as they heal, and new skin will form underneath. These photos are used with the patient's permission.

MPX toolkit for healthcare providers & LGBTQIA+ organizations

This toolkit targets the MSM community, and let's them know facts about mpox and how to keep their community safe as this outbreak disproportionately hits the MSM community.

The toolkit includes an image series for Instagram/Facebook, an infographic, and a poster/flyer.



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What does MPX look like?

MPX can vary greatly in appearance. Some lesions are small, while others may develop larger lesions. MPX lesions are often filled with pus and scab over as they start to heal. Oftentimes, these lesions are painful.


What are the symptoms?

The key symptom of MPX are rashes, bumps or blisters. These may appear anywhere on the body, including the genitals. It may present similar to syphilis, herpes, etc. 

Early on in a MPX infection an individual may also feel:

  • Fever and headache

  • Muscle aches

  • Cough or sore throat

  • Malaise or exhaustion

  • Chills

  • Swollen lymph nodes

Symptom onset ranges from 5-21 days after exposure. MPX rarely results in death, although severely immunocompromised people may suffer worse outcomes. Hospitalizations also remain rare. In most instances, individuals hospitalized for MPX have been hospitalized for pain management.


How does MPX spread?

The most common way MPX is spread is through direct contact with the rash.


MPX can spread when a person has close contact with an infected person; by touching MPX lesions on a person’s skin; by encountering respiratory droplets or secretions from the eyes, nose and mouth from a person with MPX; or when a person encounters materials (bedding, towels, etc.) that are contaminated with the virus.


MPX can also spread from animals to people, although this form of MPX spread has not been reported in the U.S. this year.


To prevent the spread of MPX, infected or exposed individuals should avoid skin-to-skin contact including hugging, kissing, talking closely and sex. Touching shared fabrics, shared surfaces and objects should also be avoided.​


What can I do to lower my risk right now?

Limiting your number of sexual partners and avoiding anonymous sex can lower your risk.

Screen potential partners for symptoms. Under good lighting, look at exposed skin before touching. If your partner's skin is not warm, dry, and intact, do not touch it and encourage your partner to get assessed by a healthcare provider.


Also avoid hooking up with people who have recently had a fever or unexplained rashes.


I think I have MPX, what should I do?

Contact your primary care provider right away to get tested. If you don't have a primary care provider or are having trouble getting testing call 406-258-3896 to be connected to services.


I'm positive for MPX, what guidance should I follow?

If you test positive for MPX, Missoula Public Health (MPH) will reach out to you with specific isolation guidance. Isolate from your ENTIRE household until MPH reaches out to you. This INCLUDES PETS. Human-to-animal transmission of the virus is possible. While the comfort of a cat or dog during this uncomfortable time sounds appealing, please stay away from your pet/s.


CDC data suggest people can spread MPX from the time symptoms start until all symptoms have resolved, including full healing of the rash with formation of a fresh layer of skin. The CDC says, ideally, people with MPX would remain in isolation for the duration of illness, which typically lasts two to four weeks. 


I've been exposed to MPX, what guidance should I follow?

Missoula Public Health will reach out to you with specific guidance. In the meantime, close contacts of MPX cases should monitor their health for 21 days after their last exposure. This includes taking their temperature at morning and night and checking for other symptoms of MPX. If symptoms develop, individuals will need to isolate themselves from others.


When/where can I get the MPX vaccine?

If you fit into one of the following eligibility categories, call Missoula Public Health at 406-258-3896 to be added to the vaccine appointment wait list.

Post-exposure prophylaxis (PEP): 

  • Adults 18 years* and older who have had exposure to individuals with confirmed orthopoxvirus/MPX virus infection.  


Post-exposure prophylaxis ++ (PEP++):

  • Adults 18 years* and older who have had multiple sexual partners in the past 14 days in a jurisdiction with known MPX. 

  • This may include:  

    • Known contacts who are identified by public health via case investigation, contact tracing, and risk exposure assessments   

    • People who are aware that one of their sexual partners from the past 2 weeks has received a MPX diagnosis.

    • Gay, bisexual, other men who have sex with men, and transgender people who report any of the following in the past 2 weeks:  

      • Group sex or sex with multiple partners. 

      • Sex at a commercial sex venue or in association with an event, venue, or defined geographic area where MPX transmission has been reported.   

Pre-exposure prophylaxis (PREP):  

  • Adults 18* and older who meet one of the following criteria: 

    • Individuals who have recently had multiple or anonymous sexual partners; OR

    • Partners of individuals who have had multiple or anonymous sexual partners; OR

    • Sex workers; OR

    • Staff at establishments where sexual activity occurs (e.g., bathhouses, saunas, sex clubs); OR

    • Were diagnosed with gonorrhea or early syphilis within the past 12 months; OR

    • Persons experiencing homelessness with high-risk behaviors; OR

    • Are on HIV pre-exposure prophylaxis; OR

    • Are part of high risk cohorts identified by clinical staff in the correctional system; OR

    • Individuals deemed to have high-risk based on individual risk assessments.


Note: eligible persons, per the criteria above, who are immunocompromised (e.g., those with advanced or uncontrolled HIV) or those who have underlying medical conditions that confer increased risk for severe disease (e.g., atopic dermatitis, eczema) could be prioritized for vaccination.

  • Certain healthcare and public health response team members designated by public health authorities to be vaccinated for preparedness purposes according to ACIP guidance.  

At this time, most clinicians in the U.S. and laboratorians not performing the orthopox generic test to diagnose orthopoxviruses, including MPX virus, are not advised to receive MPX vaccine PrEP 

*For individuals under the age of 18 years, Jynneos may be administered under the current EUA as a 2-dose 0.5 mL subcutaneous injection given 28 days apart. 


What are the treatments for MPX?

Currently, there are no specific approved treatments for MPX  infections, but CDC says antivirals such as tecovirimat (TPOXX) may be recommended for people who are more likely to get severely ill. Although TPOXX is only FDA-approved to treat smallpox, it has been used in a small number of MPX patients nationwide. Many of these patients have reported that the TPOXX lessened the pain associated with MPX. Montana DPHHS has a small stockpile of TPOXX. If you have MPX and are in severe pain, reach out to your primary care physician and let them know if you are interested in trying TPOXX.


The information I'm looking for wasn't covered here

The CDC's website has robust information on MPX. Please visit the CDC MPX page here

Image by Sharon McCutcheon


Lastly, but most importantly, there should be no stigma attached to mpox. Anyone can get mpox and blaming one community may harm public health efforts or cause providers to misdiagnose the illness in other populations. Mpox is not an STD or STI, and anyone can get it.