A Patient’s Guide to Treating Monkeypox | CPT PPP Coverage

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Monkeypox is a disease similar to smallpox. It is self-limited (resolves without treatment), usually lasting two to four weeks. Most people with monkeypox get better without treatment.

Currently, there is no specific treatment approved for monkeypox virus infection. The treatment is focused on managing symptoms such as headaches, fever, chills, muscle aches, sore throat, swollen lymph nodes, and a chicken pox–like rash that can develop on the hands, feet, face, chest, mouth, tongue, genitals, or anus.

Monkeypox rarely causes death, but complications such as vomiting and diarrhea may require supportive care to prevent dehydration. Some people may also require treatment for rare eye complications such as blepharitis (infection of the eyelid) or conjunctivitis (“pink eye”).

This article explains how monkeypox is currently treated, including self-care, over-the-counter (OTC) medications, and prescription drugs. It also explores which complementary and alternative therapies may be useful in supporting standard treatments.

Home Remedies and Self-Care

The symptoms of monkeypox can vary from one person to the next. Some people experience flu-like symptoms before the outbreak of rash, some get the rash first followed by symptoms, and others get only the rash.

The main approach to resolving the flu-like symptoms of monkeypox is rest. Most people who get monkeypox will experience fatigue and lethargy and will benefit from many of the same self-care treatments for flu, namely getting plenty of rest and plenty of fluids.

The monkeypox rash may be difficult to deal with because it can be extremely painful. Even after the blistering rash starts to heal, many people will experience intense itching and find it hard to resist scratching.

To better cope with the monkeypox rash and reduce pain, itching, and the risk of infection, try the following:

• Apply a cold compress or a cold cloth to the sores to reduce inflammation and pain.
• Use a sitz bath (sitting in a shallow pan of warm water) to soothe and clean sores on the genitals or anus.
• If you have mouth sores, sipping ice water or sucking on ice chips can help relieve pain.
• Rinsing with salt water and/or baking soda can reduce inflammation and help mouth sores heal faster.
• Wear light clothing and undergarments to avoid the buildup of moisture and heat that can add to the discomfort and promote bacterial growth.
• Trim your nails and wear soft cotton gloves or mittens if you find yourself scratching at night.
• Avoid touching your eyes, which can transmit the virus to your eyelid or the lining of your eye.
• Keep the open sores covered when around others to avoid the spread of infection. But don’t cover them with bandages as this can increase moisture and interfere with healing.

Over-the-Counter (OTC) Medications

Certain OTC medications may be helpful in managing the rash, flu-like symptoms, and other complications of monkeypox infection, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These include Advil (ibuprofen) and Aleve (naproxen), which can relieve inflammation, pain, redness, and swelling. NSAIDs also have analgesic (pain-relieving) properties that help ease headaches. Do not use for more than a day or two, because these drugs can cause stomach ulcers and worsen kidney function.
• Tylenol (acetaminophen): Tylenol is a non-NSAID pain reliever that has potent analgesic and antipyritic (fever-reducing) properties.
• Antihistamines: Oral antihistamines, used to treat allergies, may help ease itching. Options include Claritin (loratadine), Zyrtec (cetirizine), and Allegra (fexofenadine). Benadryl (diphenhydramine) can cause drowsiness and may help you sleep if itching keeps you up at night.
• Topical medications: These include antihistamine creams, low-potency hydrocortisone cream, calamine lotion, and numbing creams containing lidocaine.
• Mouthwash and oral ointments: Antiseptic mouthwashes containing hydrogen peroxide or chlorhexidine are useful for treating mouth sores. There are also oral gels containing benzocaine that can help relieve mouth pain.
• Antidiarrheals: Oral medications like Imodium (loperamide) and Pepto-Bismol or Kaopectate (bismuth subsalicylate) help ease diarrhea. Electrolyte-rich oral rehydration drinks like Gatorade or Pedialyte may be needed if symptoms are severe to prevent dehydration.
• Antinausea medications: Kaopectate and Pepto-Bismol are also useful for easing nausea and vomiting. The antihistamine Dramamine (dimenhydrinate) can also help. Pedialyte may be better tolerated than Gatorade as an oral rehydration solution as it has less sugar.
• Medicated eye drops: Mild blepharitis and conjunctivitis may respond well to antihistamine eyedrops, decongestant eye drops, and artificial tears available over the counter.

Prescriptions

There are no drugs approved or licensed for the treatment of monkeypox virus. However, because monkeypox is closely related to smallpox, an antiviral drug called TPOXX (tecovirimat) may be used off-label in people with severe infections or at increased risk of complications.

People at risk include children (especially those under age 8), people who are pregnant or breastfeeding, and immunocompromised people (such as those with untreated human immunodeficiency virus, HIV). People with atopic dermatitis (the most common form of eczema) or other chronic skin conditions may also be candidates for treatment.

TPOXX is delivered in capsule form and taken by mouth twice daily for 14 days with a high-fat meal. Side effects include headache, nausea, abdominal pain, and vomiting.

If you are prescribed TPOXX, you will be asked to sign a consent form stating you understand TPOXX is an investigational drug (still being researched) and not yet licensed for the treatment of monkeypox.

Other prescription drugs may be used to treat complications of monkeypox, such as secondary bacterial infections and eye infections. This may involve:

Complementary and Alternative Medicine (CAM) Treatments

Although no complementary or alternative medicines (CAMs) can alter the course of a monkeypox infection, certain ones may help ease symptoms or complications.

The evidence supporting the use of CAMs in treating any poxvirus infection is generally weak, but four natural compounds that may be of benefit based on research are:

• Colloidal oatmeal: This is an age-old remedy consisting of powdered oat kernels that can be used for oatmeal baths to relieve pain and itching. The Food and Drug Administration (FDA) has classified colloidal oatmeal as a skin protectant.
• Ginger: Whether taken as a tea, as a supplement, or as a fresh root, ginger (Zingiber officinale) is thought to relieve nausea and vomiting by blocking so-called 5-HT3 receptors in the gut. These are the receptors that transmit nerve signals to the brain that trigger emesis (vomiting).
• Purple pitcher plant: Known as Mqo’oqewi’k by Native American tribes, the purple pitcher plant (Sarracenia purpurea) has been used since the 19th century as a salve for pox-like rashes. A 2012 study reported that the plant did exert antiviral action against smallpox and other poxviruses.
• Tea tree oil: This essential oil is made from the leaves of the melaleuca, or tea, tree (Melaleuca alternifolia). It contains an anti-inflammatory compound known as terpinen-4-ol that has been shown to promote the healing of skin rashes caused by the poxvirus molluscum contagiosum.

Summary

There are no approved or licensed treatments for monkeypox. The treatment instead is focused on managing symptoms and preventing complications. Most monkeypox infections will resolve on their own within two to four weeks.

People with severe symptoms or those at risk of complications may be prescribed TPOXX, a drug currently licensed for the treatment of smallpox.

A Word From Verywell

The outbreak of monkeypox in the United States in 2022 spurred alarm in hard-hit communities, particularly among men who have sex with men (MSM). While the infection can be painful and unsightly, most cases will resolve on their own without incident.

Until there is an effective treatment for monkeypox, your best defense may be to get the monkeypox vaccine if you are at risk of exposure through sex or intimate contact. If you think you’ve been exposed to monkeypox by any means, you may still benefit from vaccination. Speak with a healthcare provider.