1. Mpox transmission is increasing in Sydney and regional NSW
2. Symptoms can be subtle, particularly in people who are fully or partially vaccinated
3. Encourage vaccination in all gay, bisexual, and other men who have sex with men (MSM),
their sexual partners and sex workers
Mpox is spreading across NSW
• 63 cases of mpox have been notified in NSW since mid-June 2024; most were acquired in NSW
• Transmission has occurred in regional NSW as well as in Sydney
Mpox can mimic other infections (e.g. genital herpes or syphilis)
• Presentations vary: 1-2 lesions at a single site, disseminated lesions, proctitis without lesions
• When present, lesions are usually on the anogenital or oral skin or mucosa, but can occur anywhere
• Only some cases have a prodrome (fever, malaise, myalgia, and/or lymphadenopathy)
For additional clinical images see: who.int/publications/i/item/WHO-MPX-Clinical-Lesions-2023.1
Test all MSM with compatible symptoms; this includes proctitis without visible lesions
• Test MSM with symptoms, regardless of vaccination status, travel history, or past history of mpox
• Consider mpox in sexual partners of MSM, sex workers, and their partners, regardless of gender
• Wear PPE, including gown, gloves, surgical mask, and eye protection
• Collect fluid from a deroofed pustule or vesicle using a dry swab. If there are no fluid-filled lesions,
send lesion tissue or crusts in a dry container. Send specimens for mpox PCR.
• A dry swab of the anorectal mucosa can be sent for mpox PCR in patients with anal symptoms
• For further testing advice: https://sti.guidelines.org.au/sexually-transmissible-infections/monkeypox/
Advise patients to cover all lesions and abstain from sex
• Tell people being tested for

mpox to keep lesions covered with clothing or a dressing and abstain from
sex while awaiting the result. If positive, the public health unit will contact the person with further advice.
• If mpox is considered the most likely diagnosis, notify the public health unit (PHU) by telephone as
soon as practicable - 1300 066 055.
Check MSM have had both doses of vaccine and encourage vaccination for those at risk
• Vaccination is recommended and available at no cost to all gay and bisexual men, their sexual
partners and sex workers. Find a vaccine clinic: health.nsw.gov.au/mpox-clinics
• People who are not fully vaccinated and report sexual or other close contact with someone with
mpox should be offered post-exposure preventive vaccination (PEPV) to prevent or attenuate
disease. PEPV is ideally given within 4 days of exposure, but may be given up to 14 days postexposure. For further guidance, call the PHU on 1300 066 055 or see: health.nsw.gov.au/mpox-pep
Further advice
• Additional information: health.nsw.gov.au/mpox
• Your local sexual health clinic (health.nsw.gov.au/sexual-health-clinics) or Sexual Health Info Link
on 1800 451 624, Monday to Friday 9am - 7pm; select option 1 for health professionals.

Dr Jeremy McAnulty PSM
Executive Director, Health Protection NSW