Monkeypox: What We Know

Last updated: Tuesday, July 5     

The monkeypox virus is circulating in Ontario and has mostly been reported among gay and bisexual men so far. It seems to be passing through close personal and sexual networks, though more information is available as time goes on.

We have compiled information from public health authorities—including Toronto Public Health, Public Health Ontario, and the office of the Chief Medical Officer of Health—along with the most recent news reports and published scientific research. The information on this page is meant to help people in our community understand what’s going on, what to look for, and where to get care. We’re keeping an eye out for reliable sources and updating this page regularly.

Monkeypox: The Basics

It’s a virus that can cause a rash, lesions, or blisters, along with fever, muscle aches, and extreme tiredness. Both animals and humans can contract the virus, and it’s spread by close and prolonged contact. It’s in the same family as smallpox, but monkeypox is less contagious and has milder symptoms. 

Most cases are reported in central and western African countries. It’s very rare to see cases in Canada or the US, and it does not look like any of these cases are linked to travel to central or western African countries. 

Symptoms typically show up within about five days of exposure to monkeypox, but can take up to 21 days to show up. They can include: 

  • A rash or blisters in your mouth (like a canker sore), on your face, around your genitals, or around or in your butt
  • Swollen lymph nodes 
  • Fever and chills 
  • Muscle aches 
  • Headaches 
  • Exhaustion 

Very serious symptoms are possible but are less common. Recently, between 3%-6% of cases have led to death. 

In this most recent outbreak, some people had the rash or blisters appear first before feeling tired and feverish. And in some cases, people didn’t have any noticeable symptoms. 

  • Photos of Monkeypox Lesions (Graphic):

    These photos were taken of people with confirmed cases of monkeypox in the UK, Italy, and Australia in May 2022. 

    Images of skin lesions from monkeypox virus Images of skin lesions from monkeypox virus

    Images of skin lesions from monkeypox virus

    Monkeypox lesions on the face and at the base of the penis.

    Images of skin lesions from monkeypox virus

    Monkeypox lesions around the mouth and around the ass.

    The full reports on these cases are available at the bottom of this page.

  • Transmission, Treatment, Care

    HOW DOES IT GET PASSED ALONG? 

    The monkeypox virus can be transmitted by respiratory droplets, by touching a lesion or blister, or contaminated surfaces like clothes or bedding.  

    It typically needs prolonged face-to-face or body contact to spread. That means it doesn’t tend to spread very quickly or very far. 

    So far, it seems like the current outbreak is mostly linked to extended skin-to-skin contact, sex, kissing, or very close talking. It seems very unlikely that it’s been passed along just by being in the same space as someone else, a handshake or hug, or walking by another person. 

    It is possible to pass on the virus in the days before you have any noticeable symptoms.

    CAN YOU GET IT FROM SEX?

    Maybe. We know that it’s transmitted through close contact like kissing, humping, or cuddling. So, if you’re close enough to have sex, there’s a chance of getting it or passing it along.  

    Traces of the virus have been found in cum in people who have confirmed cases of monkeypox and still have the other symptoms. We don’t know yet how long it might be in cum or other sexual fluids after other symptoms have cleared up. And we don’t know if the amount of the virus in cum is enough to pass it along to someone else. There’s no evidence that has linked cum to any cases yet. In one case in Italy, it was found that the virus in a patient's cum was capable of infecting another person. More research and evidence are needed.

    Public health authorities in the UK have suggested wearing a condom during sex for up to 8 weeks after other symptoms have cleared in order to be extra cautious. This would probably only be effective if you used a condom the entire time you had sex, including when giving or getting head, and didn’t get cum anywhere other than in the condom. 

    WHAT’S THE TREATMENT? 

    There’s currently no specific treatment or cure for monkeypox in humans, so it mostly runs its course and is dealt with by our immune system. Most treatments are for the symptoms, and if there are lesions, they should be covered with a bandage to make it less likely to spread to others. If you have a confirmed case, isolate and wear a mask if you’re in close contact with someone until the lesions clear up (usually 2-4 weeks).

    Treatment for smallpox might be used in some emergency cases in hospital, but it's not common.

    WHEN TO GET HELP 

    If you notice these symptoms—especially a rash or blisters—isolate and contact your primary care provider, sexual health clinic, or public health unit right away. Same goes for if you have been in close contact (ex. had sex with, kissed, cuddled) someone with either symptoms of or a confirmed case of monkeypox. 

Monkeypox and Pride

Across Ontario, our community is coming together to experience the joy (and sex!) that Pride offers.

Here are some things to be aware of and some things we can all do throughout Pride season to take care of our sexual health.

  • Visit your family doctor or local sexual health clinic and get a full screening for sexually transmitted infections (including syphilis and HIV). Remember to ask for swabs alongside the other tests. For a lot of us, testing includes our throat and asshole in addition to peeing in a cup and having our blood taken.
  • Check around your ass and genitals for any new bumps, lumps, rashes or anything else that might look unusual for you.
  • If you notice anything, schedule a visit with your healthcare provider
    • You might need to remind them that monkeypox is going around the community.
  • If you develop symptoms of monkeypox before Pride, consider isolating and avoiding close contact—including sex— until you have been assessed by a healthcare provider and they have ruled out monkeypox.
  • Consider how much close contact is likely to happen at the events and venues you’re going to.
  • Continue to take your PrEP or HIV medications as prescribed.
  • Keep condoms and lube on hand. There’s a chance that monkeypox can be transmitted through cum, but condoms are still helpful at preventing other STIs.
  • Think about limiting the number of partners you have or going to events or venues with a lot of close contact.
  • If you can, having some basic contact info for the people you have sex with or get close to—whether at venues or on hook-up apps—can be helpful if you need to contact them for potential monkeypox exposure.
  • Other ways you can reduce the risk of monkeypox:
    • Avoid sharing—lube, sex toys, fetish gear, douching equipment, toothbrushes, substance use equipment like pipes and syringes, bedding, towels and clothing.
      • If sharing, try to use barriers like gloves for fisting and condoms on sex toys. Change them out between sex partners.
    • The more sexual partners you have, the higher chance that you might be exposed to monkeypox or pass it on.
  • Talk openly with your partners about your sexual health and theirs—Pride is a joyful time, and it’s up to all of us to care for each other.
  • Monitor for any symptoms of monkeypox including any new bumps, lumps, rashes, or anything else that might look unusual for you.
  • Follow the guidance of your doctor, sexual health clinic staff, or other healthcare provider.
    • You might need to remind them that monkeypox is going around the community.
  • Visit your family doctor or local sexual health clinic and get a full screening for sexually transmitted infections (including syphilis and HIV). Remember to ask for swabs. For a lot of us, testing includes our throat and asshole in addition to peeing in a cup and having our blood taken.

Vaccine Information

IS THERE A VACCINE? 

There’s no specific monkeypox vaccine, but it looks like the smallpox vaccine is about 85% effective in reducing symptoms of it. The last countries stopped giving smallpox vaccines about 40 years ago, so anyone older than 40 might have received it, depending on where they grew up.  

The smallpox vaccine can be given to make it less likely to get severe symptoms of monkeypox, but there isn’t evidence that it can stop someone from getting it in the first place. If someone has likely been exposed to monkeypox, but doesn’t have symptoms or a confirmed case, it’s possible for them to get the vaccine as post-exposure prophylaxis (PEP), similar to HIV.

Because it was developed for smallpox and not specifically for monkeypox, there is less research available than we’d like on some of these details. That said, we do know that the smallpox vaccine is safe.

HOW SOON AFTER GETTING THE VACCINE WILL IT BE EFFECTIVE? 

It takes up to 14 days from the time you get the vaccine to have adequate protection.

VACCINATION CLINICS

Getting vaccinated against monkeypox can help reduce serious symptoms if you get it. It likely won’t stop you from getting it if you’re in close contact with someone who can pass it on. Remember: vaccines don’t work like an on/off switch. It can take two weeks for your body to process and react to the vaccine after getting it.

The Ontario government takes care of making vaccines available across the province. Local public health units take care of setting up vaccine clinics and actually giving people the vaccines. This section will be updated as we get info from the health authorities.

Toronto Vaccine Clinics

1940 Eglinton Ave. E
Scarborough

Wednesday, July 6
12:00pm – 6:00pm

Thursday, July 7
12:00pm – 6:00pm

Friday, July 8
12:00pm – 6:00pm

Saturday, July 9
10:00am – 4:00pm

250 The East Mall
Etobicoke

Wednesday, July 6
12:00pm – 6:00pm

Thursday, July 7
12:00pm – 6:00pm

Friday, July 8
12:00pm – 6:00pm

Saturday, July 9
10:00am – 4:00pm

55 John St.
Toronto

Wednesday, July 6
12:00pm – 6:00pm

Thursday, July 7
12:00pm – 6:00pm

Sunday, July 10
10:00am – 4:00pm

66 Gerrard St. East
Toronto

Sunday, July 10
11:00am – 5:00pm

Drop-in only.

For more information about the City of Toronto’s vaccine clinics, visit:

toronto.ca/community-people/health-wellness-care/health-programs-advice/monkeypox

Ottawa Vaccine Clinics

420 Cooper St.
Ottawa

Appointments are being offered over the next several weeks. You can call (613-580-6744) or check online for the next available spots.

 

179 Clarence St.
Ottawa

All eligible clients with an appointment at the OPH Sexual Health Clinic will be offered the vaccine as part of their visit.

For more information about the City of Ottawa’s vaccine clinics, visit:

ottawapublichealth.ca/en/public-health-topics/monkeypox-virus.aspx

Peel Region Vaccine Clinics

Westwood Square Mall
7205 Goreway Drive
Mississauga

By appointment only, and hours vary.
Call 905-451-4920 to book.

Wednesday, July 6

Thursday, July 7

Friday, July 8

Durham Region Vaccine Clinics

419 King St W.
West side mall entrance
Lower level
Oshawa

By appointment only. Visit durham.ca/monkeypox to book.

Thursday, July 14
1:00pm – 8:00pm

1899 Brock Rd., Unit C3
(former Winners location)
Pickering

By appointment only. Visit durham.ca/monkeypox to book.

Saturday, July 9
9:00am – 4:00pm

To book an appointment and find more information about the Durham Region vaccine clinics, visit: 

durham.ca/monkeypox

London Vaccine Clinics

MLHU CitiPlaza Training Rooms
110-355 Wellington St.
London

Friday, July 8
9:00am – 12:00pm
Drop-in

York Region Vaccine Clinics

17150 Yonge St., 3rd Floor
Newmarket

By appointment and drop-in. Book at york.ca/monkeypox.

Friday, July 8
9:30am – 4:30pm

Friday, July 15
9:30am – 4:30pm

50 High Tech Rd., 2nd Floor
Richmond Hill

By appointment and drop-in. Book at york.ca/monkeypox.

Saturday, July 9
10:00am – 4:00pm

Thursday, July 14
10:00am – 4:00pm

Took book an appointment and find more information about the York Region vaccine clinics, visit:

york.ca/monkeypox

Bathhouse and Community Agency Clinics

There are smaller clinics planned at bathhouses and community agencies across the province. They are targeted at the specific clientele and community members connected to each of these spaces. They also typically have fewer doses available and can’t always handle lots of people, so won’t be listed here. 

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If you don’t see your community in this list, please contact your local public health unit or call the Sexual Health Infoline Ontario (SHILO). SHILO is a free, province-wide anonymous counselling service on HIV, STIs, safer sex, referrals to sexual health services, testing information, harm reduction in drug use, and needle exchange information.

416-392-2437 / 1-800-668-2437 (English and multilingual Line) 

You will not be asked to pay for the vaccine. You do not need an OHIP card to get the vaccine.

Note: The GMSH is sharing this information to support our community and to promote vaccination for those of us who may benefit from it. We aren’t responsible for running any of the clinics, how many doses are available, or the individual experience of people at the various vaccine clinics that are set up across the province.

Who should get the vaccine?

You should consider getting vaccinated against monkeypox (Imvamune, the smallpox vaccine) if you have had an STI in the last two months, if you have sex with multiple partners, if you have anonymous sex, if you go to places where sex happens (like the bathhouse), or if you do sex work.

The current eligibility criteria determined by the Ontario Ministry of Health are:

Trans- or cis-gender individuals who self-identify as belonging to the gay, bisexual and other men who have sex with men (gbMSM) community AND at least one of the following:

  • Have received a diagnosis of bacterial STI (i.e., chlamydia, gonorrhea, syphilis) in the past 2 months;
  • Have had 2 or more sexual partners within the past 21 days or may be planning to;
  • Have attended venues for sexual contact within the past 21 (e.g., bath houses, sex clubs) or may be planning to, or who work/volunteer in these settings;
  • Have had anonymous/casual sex in the past 21 days (e.g., using online dating/ hookup apps) or may be planning to;
  • Engage in sex work or may be planning to, and their sexual contacts.
  • How serious is monkeypox?

    Monkeypox is a serious disease. While many people who get monkeypox won't have really bad symptoms, lots of people in the current outbreak are. Some (but not most) people have ended up in the hospital, and people who have had more serious symptoms reported severe pain; blisters and open sores in their mouth, on their face, ass, or dick; and—in some cases—bleeding from the sores or blisters they had (including from their ass).   Treatment is available for anyone hospitalized who is severely ill.

    From the case reports that have been made public in the current outbreak, we know that people with monkeypox can experience a range of symptoms with varying degrees of pain and discomfort. Depending on how well the lesions heal, scarring is possible.   

  • Is the vaccine safe?

    For the vaccine that is being used in Ontario (called Imvamune), past research suggests that it is at least 85% effective in preventing monkeypox. It is authorized for use in Canada in people 18 years and older and requires 2 doses delivered by injection into the arm at least 28 days apart. You can receive the vaccine regardless of when or whether you were vaccinated for COVID-19.

    According to the Public Health Agency of Canada, Imvamune’s safety has been assessed in 20 completed clinical trials where approximately 13,700 vaccine doses were given to 7,414 individuals.

    Is the vaccine safe for people living with HIV?

    People living with HIV who take HIV treatment have less sever experiences with monkeypox. People living with HIV who have a CD4 count of less than 100, have persistent high viral load, or are otherwise immunocompromised may experience more severe illness and should talk to their healthcare provider before getting the vaccine.

    The vaccine that you will be offered is safe and studies included people living with HIV. You may be asked about your CD4 count. Regardless, if offered the vaccine you should consider taking it for the protection and benefits it offers.

  • What are the vaccine side effects?

    Imvamune, the vaccine available in Canada, is being given as a single needle injection. It’s injected on the underside of your arm, just under the skin. 

    Most people don’t have a strong reaction to the vaccine. The most common side effects are feeling sore, some light bruising, a small bump, swelling, or a small rash around where you get the needle. 

    Some people feel tired, get headaches or muscle pain, and occasionally feel sick to their stomach. If you do experience these, they typically go away within a week. The injection shouldn’t leave a scar.

    If you do have a strong reaction, or if the side effects last longer than a week, get in touch with your healthcare provider or local public health unit.

  • Is it just affecting queer men?

    So far, reports are that it’s mostly passing through some sexual networks among men who have sex with each other, but there's no clear connection between most of the confirmed cases. There are a few cases being investigated that don’t involve gay or bisexual men, too. The virus doesn’t target people and so any prolonged contact (not necessarily sexual) can pass it along. Plus, it can live in animals, which has caused outbreaks in the past (most recently in 2003 in the US). 

  • Monkeypox and HIV

    Like many infections, the impact of monkeypox can be worse for people with weakened immune systems. For people living with HIV who aren’t on treatment or have low T-cell counts, it is possible for more complications to come up if they contract monkeypox. There’s no evidence that someone living with HIV who is undetectable has any greater risk of complications from monkeypox than someone without HIV. 

  • How concerned should you be?

    Don’t panic, but you should be aware. Being alert and telling your doctor or local public health unit about any symptoms you have can help slow its spread.

    Even if you might have a mild case, there are people in our community with compromised immune systems who could get seriously sick. 

    If you see a report of monkeypox linked to a particular place (like a club, bar, or bathhouse) that you were at, think about what you did there and if you had any close contact with people.  

    Public Health Units in Ontario are doing contact tracing for the possible cases in the province and following up directly. But for the next while, it is probably best for everyone to keep track of who they have been in close contact with (ex. kissed, had sex with, or been naked with) and be proactive about reaching out to them if you develop symptoms or have a confirmed case. Same goes for any venues you were in over the last three weeks, if you kissed, shared drinks with, or had sex with someone else who you can’t contact directly. 

  • Duty to report

    In Ontario, the Chief Medical Officer of Health has ordered all healthcare providers to report any suspected or confirmed cases of monkeypox to the CMOH and to Public Health Ontario.  

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