As monkeypox cases rise in the U.S. and around the world, getting any kind of rash or bump that's itching may cause some concern.
Last week, the Biden administration declared monkeypox a public health emergency. As of Aug. 8, there were more than 29,800 cases globally, including at least 8,900 in the United States, according to the U.S. Centers for Disease Control and Prevention.
Although an estimated 98% of cases so far are among men who have sex with men, per World Health Organization data from late July, anyone can get monkeypox — and experts have told TODAY they expect to see more transmission outside this community. For example, in the U.S. at least five monkeypox cases have been reported in kids and at least one in a pregnant woman.
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Monkeypox is spread predominantly through close, skin-to-skin contact, Dr. Paul Adamson, infectious disease physician and assistant clinical professor of medicine at the David Geffen School of Medicine at University of California, Los Angeles, told TODAY. This can include hugging, kissing or touching. The virus can also spread through respiratory secretions or contaminated materials, like bedding, towels or clothing.
So, how can you tell if a rash is monkeypox? Is itching a symptom of monkeypox? Understanding the typical signs and characteristics of monkeypox lesions can help.
What are the first symptoms of monkeypox?
A classic case of monkeypox usually starts with a “prodrome,” or a set of early symptoms that precede the rash, said Adamson. These include fever, fatigue, malaise, headache and chills. “The other main one is swollen lymph nodes (lymphadenopathy) in the armpit or groin … and interestingly, some people have been reporting sore throats,” he added.
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Typically, these prodromal symptoms last for a few days. “Usually within five days of the prodromal symptoms — but sometimes at the time of the prodromal symptoms — patients get a rash,” Dr. Scott Roberts, associate medical director of infection prevention for the Yale School of Medicine, told TODAY. But in this outbreak, many cases have looked different from the classic clinical presentation of monkeypox, NBC News previously reported.
“The thing we’ve noticed with the current outbreak is that a lot of these patients are not presenting with this initial prodrome, they’re just presenting right away with the rash,” Roberts said.
How long does it take to show symptoms of monkeypox?
“Symptoms usually appear one to two weeks after an exposure," said Roberts, but the full range of time it can take for monkeypox symptoms to appear is three to 17 days, according to the CDC.
Simply put, monkeypox symptoms usually start within three weeks of exposure to the virus.
Is itching a symptom of monkeypox?
Itching is not a common early symptom before the rash appears, experts told TODAY. “I’m not hearing about people saying there’s itching prior to the lesions. I think it’s when the lesion is present,” said Adamson.
Monkeypox lesions are typically described as more painful than itchy in the beginning, said Roberts, adding that patients have reported itching towards the end when the sores are crusting and scabbing over.
Is monkeypox itchy or painful?
The characteristic monkeypox rash is a painful lesion, Roberts said, and that pain can become very intense. “Some patients have actually had to be admitted to our hospital for pain management,” said Roberts. This may include topical treatments such as lidocaine or oral pain medication.
A New York City resident who recently contracted monkeypox told TODAY that the symptoms were so painful that they almost passed out.
So while the lesions themselves may be itchy at some point, the sensation of itching alone is not a classic symptom of monkeypox especially in the early pre-rash phase.
What does monkeypox do to the body?
The monkeypox rash is the primary way that monkeypox affects the body. It usually starts out as a flat, red discoloration of the skin which becomes a firm, raised bump within one to two days, according to experts. The classic monkeypox lesion is described as well-circumscribed, or round and defined, and deep-seated, said Adamson. "It looks like it’s coming from the deeper part of the skin. … They’re also what we call umbilicated, meaning there’s a dimple in the middle of the lesion itself."
Next, the lesions become filled with fluid or pus (called pustules) and may look yellowish, said Adamson. At this stage, the sores can resemble a pimple, but they’re typically described as very painful, he added. Eventually, the lesions will crust and scab over then fall off, and a new layer of skin forms underneath. This can take up to four weeks, the experts noted.
Usually a person has multiple lesions, not just one, said Roberts, and they're relatively similar in size and stage of development. “That contrasts it with chickenpox, where you can have rashes and all different stages of development at different times,” he added.
The rash typically starts on the face or mouth before spreading to other parts of the body, said Roberts. "If patients do have this widespread rash, it really pops up all over, so there’s multiple lesions across different parts of the body, like the trunk, back or extremities,” he added.
But this outbreak is unique because in many cases the rash has started in the genital region and may remain isolated to the area where contact with the infected person occurred, Roberts noted.
The CDC noted that the monkeypox rash can leave behind "pitted scars Pitted scars and/or areas of lighter or darker skin may" after the scabs fall off. Once there are no more scabs and there's a new layer of skin, the infected person is no longer contagious.
The experts encouraged anyone with a suspected case of monkeypox to talk to their doctor. The only way to confirm a diagnosis is by getting tested, which is done by swabbing the sores and usually takes between 24 and 48 hours to yield results.