There are several treatment options to improve the symptoms of monkeypox, including antiviral treatment and supportive care. We recommend that residents infected with monkeypox reach out to their healthcare provider to discuss these options to ensure they are safe and appropriate.
Antiviral treatment or TPOXX:
According to the CDC, you may be eligible for antiviral treatment, tecovirimat or TPOXX, if you have or are at high risk of severe disease, including if you have an immunocompromising condition, if you have monkeypox lesions in the mucus membranes, including eyes, mouth, genitals, or anus, if you are pregnant or breastfeeding, in pediatric patients, or if you experience other complications from MPV infection, such as secondary skin infections, nausea, vomiting, or diarrhea, or dehydration. For additional information, please visit the CDC website.
Supportive care includes maintenance of adequate fluid balance, pain management, treatment of bacterial superinfections of skin lesions and treatment of co-occurring sexually transmitted or superimposed bacterial skin infections. Below is general information on treatment options to improve the most common symptoms of monkeypox infections, including itching and pain. However, we recommend discussing these symptoms directly with your healthcare provider for specific guidance.
Skin care and itching
Skin lesions should be kept clean and dry when not showering or bathing to prevent bacterial superinfection.
Pruritus or itching can be managed with oral antihistamines and unscented or plain topical agents such as calamine lotion or petroleum jelly.
For oral or mouth lesions, compounds such “magic” or “miracle” mouthwashes (prescription solutions used to treat mucositis) can be used to manage pain. Oral antiseptics can be used to keep lesions clean (e.g., chlorhexidine mouthwash). Topical benzocaine/lidocaine gels can be used for temporary relief, especially to make eating and drinking easier, but should be limited to recommended doses.
For painful genital and anorectal lesions, warm sitz baths lasting at least 10 minutes several times per day may be helpful. Pat the area dry. Topical benzocaine/lidocaine gels or creams at the recommended doses may also provide temporary relief.
Proctitis can occur with or without internal lesions and, though often manageable with appropriate supportive care, can progress to become severe and debilitating. Stool softeners such as docusate should be initiated early. Sitz baths, as described above, are also useful for proctitis, and may calm inflammation. Similarly, over the counter pain medications such as acetaminophen can be used. Pain from monkeypox proctitis may require prescription medications, use of which should be balanced with the possibility of side effects, like constipation. Proctitis may additionally be accompanied by rectal bleeding. Though rectal bleeding has been observed to be self-limited, patients with rectal bleeding should be evaluated by a healthcare provider.
Nausea and vomiting
Nausea and vomiting may be controlled with anti-emetics as appropriate. Diarrhea should be managed with appropriate hydration and electrolyte replacement. The use of anti-motility agents is not generally recommended given the potential for ileus, unless discussed or prescribed by a healthcare provider.
If you are a healthcare provider seeking additional information on TPOX eligibility, please see CDC guidance. If you are a patient infected with monkeypox and believe you may be eligible for TPOXX, we recommend asking healthcare provider about treatment.
Centers for Disease Control and Prevention, “Guidance for Tecovirimat Use Under Expanded Access Investigational New Drug Protocol during 2022 U.S. Monkeypox Cases”, July 15, 2022
NYC Health, “Interim Guidance for Treatment of Monkeypox”, July 2, 2022