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As monkeypox outbreak spreads, these pictures can help you identify symptoms

Even as U.S. cases of monkeypox decline, the CDC is urging the public to know the symptoms and when to contact a health care professional.

Monkeypox cases in the U.S. have drastically declined in recent weeks, but the Centers for Disease Control and Prevent still want the public to be aware of symptoms of the virus and when to contact a health care professional. And familiarizing yourself with monkeypox pictures can help you follow this guidance.

The monkeypox outbreak first hit the U.S. in May 2022, and cases ticked up rapidly over the summer, hitting a peak of 736 new cases in one day in late August, per CDC data. The U.S. has more cases than any other country — over 26,000. Monkeypox is a virus spread through close, usually skin-to-skin contact and results in a rash and flu-like symptoms, such as fever, aches, sore throat and cough.

Pictures of monkeypox symptoms and rash from UK Health Security Agency.
Pictures of monkeypox symptoms and rash from UK Health Security Agency.GOV.UK

However, once September hit, the number of new monkeypox cases per day in the U.S. often dropped to double digits, with a low of 14 on Sept. 25. According to an NBC news analysis of monkeypox case data, the seven-day average of reported new cases dropped to 144 on Sept. 28, down from 437 just seven weeks prior on Aug. 10.

The decrease, driven by declining rates in major cities like New York and Los Angeles, may be due to vaccination efforts and the most-at risk communities changing their behavior. Still, it's important to note that at this stage in the outbreak, people of color are being disproportionately affected, with Black people making up 51% of new cases the week of Sept. 18, the most recent data available.

The monkeypox outbreak was declared a national public health emergency in the U.S. in early August, shortly after the World Health Organization also declared it a public health emergency of international concern, its highest alert. But cases are now on the decline globally, too, according to WHO data; the number of new cases declined by 16.8% the week of Sept. 26 compared to the week prior. To date, there have been 68,874 confirmed cases in the global outbreak, with all but 705 cases in countries that haven't historically reported cases of monkeypox.

Even as cases are trending in the right direction in the U.S. and abroad, we're still learning about the virus. The CDC issued a warning on Sept. 29 about severe illness from monkeypox in immunocompromised individuals, which came around the same time that a third U.S. patient died from the virus, CNBC reported. What's more, the CDC said in a technical report also on Sept. 29 that "low-level transmission" of monkeypox could continue "indefinitely," and it's not clear how many cases may accumulate.

RELATED: How at risk are kids in the monkeypox outbreak?

The states that have the most cases of monkeypox are: California, with 5,010, New York with 3,948, Florida with 2,543, and Texas with 2,372. At least 31 cases of monkeypox in kids have been reported in the U.S, according to state health officials.

Monkeypox pictures and timeline

Monkeypox is a rare disease that’s usually found in Central and West Africa. In humans, there are two types of monkeypox virus, which WHO recently renamed: clade one, formerly known as the Congo Basin variant, and clade two, formerly known as the West African clade. Clade two is driving the current outbreak and has a survival rate of 99% whereas clade one has a 10% fatality rate.

Monkeypox symptoms usually appear within three weeks of exposure. Usually, flu-like symptoms will appear first, followed by a rash one to four days later. The rash may be on or near the genitals or anus, as well as other parts of the body, such as the hands, feet, chest, face or inside the mouth, according to the CDC. The illness typically lasts two to four weeks.

monkeypox pictures
Pictures of monkeypox symptoms and rash, from the CDC.CDC

Some of the most common monkeypox symptoms reported in the current outbreak have been lesions around the genitals and anus, fever, swollen lymph nodes, oral sores and pain when swallowing, per WHO. In some patients, the rash has appeared before flu-like symptoms, and it only affected one part of the body, such as the genitals. (In other patients, it started around the genitals or anus and then spread.)

A recent study in the journal BMJ found that almost half of the 197 participants, all of whom had tested positive for monkeypox, had lesions on the skin or mucus membranes as their only symptom, or their systemic symptoms, like fever, appeared after the lesions. The study authors also noted the "predilection" of the lesions to the genital and anal areas, as well as in and around the mouth and throat. Also, some patients had solitary lesions that did not spread.

The study authors theorized that these trends may be due to the virus spreading from sex and the rash popping up where the virus entered the body as the first symptom. Most cases in the outbreak have been tied to sex between men, another study found.

The first U.S. monkeypox case was in May in a Massachusetts man who’d traveled to Canada, and his rash first appeared around his anus and genitals, according to a June CDC report. Also this past May, a New York City resident with monkeypox was treated for an oral lesion and rash around the anus initially presumed to be a common sexually transmitted infection. Another monkeypox patient in New York City told TODAY that their symptoms started out like the flu before sores appeared on the face and anus.

monkeypox picture
A picture of a monkeypox lesion from New York City resident Jack Richards, who was diagnosed with monkeypox in July and shared their story with TODAY.Courtesy Jack Richards

Many monkeypox patients have been sharing pictures and videos of their symptoms to raise awareness and stem the spread. A 40-year-old man from Texas who goes by Silver Steele on social media shared a photo timeline of his monkeypox rash, which has gone viral. He told TODAY his first symptom was a few small blisters; a few days after they appeared, he experienced flu-like symptoms.

Prior to this pandemic, monkeypox symptoms usually began with fever, headache, back aches and lethargy lasting one to two days, explained Rosamund Lewis, WHO’s head smallpox secretariat. Traditionally, next a rash will appear, which starts as red discoloration in the skin. It usually starts on the face and then progresses to the arms and legs, then hands and feet, and then the rest of the body. This phase also lasts one to two days. Next comes what are referred to as papules, when the rash becomes raised on the skin, instead of flat. This also lasts one to two days.

monkeypox pictures
GOV.UK

Next is the vesicle phase, or as Lewis called them, “blisters,” when lesions are raised and filled with clear fluid, usually starting on the fourth or fifth day of symptoms and lasting another one to two days.

Vesicles are followed by pustules, when the blisters “fill with a whitish fluid that looks like pus,” Lewis said, usually around the sixth or seventh day of symptoms. According to the CDC, they’re usually “firm to the touch,” develop a dent in the center (called an umbilication) and last an additional five to seven days. (The BMJ study on symptoms in the current monkeypox outbreak noted that some participants' lesions did not become pustular or ulcerated.)

Monkeypox pictures
In this Centers for Disease Control and Prevention handout graphic, symptoms of one of the first known cases of the monkeypox virus are shown on a patient's hand May 27, 2003.CDC via Getty Images

After about two weeks of symptoms, the lesions then start to crust and scab over, and the scabs last for another week before falling off. Scars and skin discoloration may persist after the scabs are gone, but you’re no longer contagious after the scabs have all fallen off.

Monkeypox pictures
In this Centers for Disease Control and Prevention handout graphic, symptoms of one of the first known cases of the monkeypox virus are shown on a patient's hand June 5, 2003.Getty Images

The CDC is encouraging anyone with a new or unexplained rash to avoid close contact, including sex, until you've seen a health care provider. When you see the health care provider, wear a mask and remind them that monkeypox is circulating in the U.S.

If you are a close contact of someone with monkeypox, meaning you were exposed to the virus, you can continue with your daily routine as long as you don't have any symptoms. That said, continue to look for symptoms for three weeks after your exposure, consider getting vaccinated, and see a health care provider right away if you develop a new rash.

Monkeypox symptoms and transmission

Monkeypox symptoms are similar to those of smallpox, including fever, headaches, muscle aches, chills exhaustion and a rash similar to pimples or blisters, which can pop up on the face, in the mouth, on the hands, feet, chest, genitals or anus. But monkeypox is much less contagious than smallpox. There is no specific treatment for monkeypox, but the smallpox vaccine, antivirals and other treatments can be used to control an outbreak.

According to the CDC, the monkeypox virus spreads primarily through direct contact with the sores or bodily fluids of someone infected with monkeypox or materials that have come in contact with bodily fluids or sores of an infected person. It may also spread through contact with respiratory secretions. These methods of transmission may occur during intercourse or other sexual contact, such as kissing, massaging or hugging, or through prolonged face-to-face interactions.

It's still unknown whether monkeypox can spread if a person was exposed but doesn't have any symptoms, how often it's spread through respiratory secretions, or if it can spread through semen, vaginal fluids, urine or feces.

To prevent the spread of monkeypox, the CDC recommends:

  • Avoiding skin-to-skin contact with people who have a rash that looks like monkeypox
  • Not touching the rash or scabs of person with monkeypox
  • Not kissing, hugging, cuddling or having sex with someone with monkeypox
  • Not sharing eating utensils or cups with a person with monkeypox
  • Not touching bedding, towels or clothing of a person with monkeypox

The virus can also spread from animals to humans through a bite or scratch by handling wild game or using products made from infected animals. And there's reason to believe monkeypox can spread from humans to animals, TODAY previously reported. Medical journal The Lancet recently investigated the "first case of a dog with confirmed monkeypox virus infection that might have been acquired through human transmission." No cases had been reported in domesticated animals prior, the study authors noted.

Monkeypox virus outbreak 2022

The World Health Organization has been tracking the multi-country outbreak since May. The outbreak is noteworthy because it's the first came so many cases of the virus have been reported in so many countries where the virus is not endemic, a WHO spokesperson said in May.

The current outbreak is being primarily driven by sex between men, research shows. In the BMJ study, all 197 participants identified as men, and 196 identified as gay; 96% reported recent sexual contact.

"The clinical presentation of these infections suggest that sexual transmission, not just close physical contact, may be helping spread the virus among this population," Jennifer Nuzzo, an epidemiologist at Brown University, told NBC News.

But it's important to note that anyone can get monkeypox through close contact and that it's "not a gay disease," Andy Seale, adviser to WHO’s HIV, hepatitis and sexually transmitted infection programs, said early on in the outbreak.

The Jynneos vaccine appears to be effective at protecting against monkeypox, according to recent CDC data, which found that unvaccinated men eligible for the vaccine were 14 times more likely to develop monkeypox than men who'd received at least one dose. Roughly 800,000 doses have been administered in the U.S. to people at high risk of becoming infected with monkeypox.

The CDC recommends anyone exposed to monkeypox or with an increased risk of exposure, like people who work with monkeypox lab samples, be vaccinated against the disease. However, eligibility for the monkeypox vaccine depends on where you live. Contact your local health department to find out if you qualify for a vaccine.

If you're concerned that you've been exposed to monkeypox or have monkeypox symptoms, visit a heath care provider, the CDC advises. If you believe you have monkeypox symptoms, you should also avoid contact with other people and animals until you test negative.