Healthcare

A high index of suspicion for monkeypox is warranted when evaluating people with the characteristic rash, particularly for the following groups:

• Men who report sexual contact with other men and who present with lesions in the genital/perianal area,
• People reporting a significant travel history in the month before illness onset, or
• People reporting contact with people who have a similar rash or have received a diagnosis of suspected or confirmed monkeypox. 

Recommendations for Monkeypox supportive care

Supportive care includes maintaining hydration and pain management

Skin lesions

• Keep lesions clean and dry when not showering or bathing to prevent bacterial superinfection.

• Manage pruritus with oral antihistamines, inert anti-irritant topical agents such as calamine lotion or petroleum jelly, and cooling lotions such as menthol and camphor lotions.

• Take warm oatmeal baths to reduce pruritus and pain.

• Advise to seek medical care if they observe an increase in pain, redness, swelling or milky/cloudy fluid at the site of the sores.

Oral lesions

• Rinse mouth with salt water at least four times a day.

• Keep lesions clean by using alcohol-free oral antiseptics, such as chlorhexidine mouthwash.

• Suck on ice chips or ice pops to reduce pain or use compounds such as “magic” or “miracle” mouthwashes used to treat mucositis.

• Use topical treatments (e.g., benzocaine gels) for temporary pain relief and to facilitate eating and drinking.

• Painful genital and anorectal lesions

• Take warm sitz baths lasting at least 10 minutes several times per day.

• Use topical benzocaine/lidocaine gels or creams.

Proctitis

• Use stool softeners such as docusate at the first sign of proctitis.

• Take sitz baths to calm inflammation.

• Take pain medications such as acetaminophen and ibuprofen.

• Apply topical anesthetics such as dibucaine ointment (often used for hemorrhoids) or lidocaine gel.

Gastrointestinal symptoms

• Control nausea and vomiting with antiemetic drugs.

• Manage diarrhea with appropriate hydration and electrolyte replacement.

• Generally, avoid anti-motility agents given the potential for ileus.

Titanji B, Tegomoh B, Nematollahi S, KonomosM, Kulkarni PA. Monkeypox-A Contemporary Review for Healthcare Professionals. Open Forum Infectious Diseases.2022. https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofac310/6615388

World Health Organization. Clinical Management and Infection Prevention andControl for Monkeypox-Interim Rapid Response Guidance. June 10, 2022.

https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1

Clinicians suspecting monkeypox infection should immediately contact IDPH

• During business hours call: (800) 362-2736
• After hours call: (515) 323-4360 (the Iowa State Patrol will contact the epidemiologist on call) 

Monkeypox Specimen Collection Guidance

Sample collection instructions from the State Hygienic Lab: http://www.shl.uiowa.edu/testmenu/menupages/orthopoxvirus.xml