1. Mpox is circulating in NSW amongst men who have sex with men (MSM)
2. Vaccinated people may present with only 1-2 anogenital lesions
3. Encourage mpox vaccination in eligible people presenting for routine care
Mpox is circulating in NSW
• Eight cases of mpox were diagnosed in MSM in NSW in the last week; some have been linked to an
outbreak in Victoria, but local transmission has also occurred
• Mpox transmission is continuing to occur in Victoria and Queensland
Vaccinated people may present with only a few lesions
• Clinical presentation includes:
o vesicular rash/lesions, often in the genital area, but can occur on any part of the body
o vaccinated people are presenting with subtle signs/symptoms – e.g., 1-2 anogenital lesions only
o painful proctitis without visible lesions
• Prodrome may occur with fever, malaise, myalgia, and/or lymphadenopathy
Test all MSM with compatible symptoms even if vaccinated and few lesions
• Test all MSM with compatible symptoms, regardless of severity, vaccination status, or travel history
• Re-infection is rare but possible; test MSM with symptoms, even if previously infected
Collect dry swabs or lesion tissue/crusts
• Wear a surgical mask, gown, and gloves while examining and taking swabs
• Swab deroofed pustule or vesicle using a dry swab; use separate swabs for multiple lesions
• If no fluid-filled vesicles/pustules are present send lesion tissue or crusts in a dry container
• A dry anorectal swab can be sent for patients with anal symptoms
• Request PCR for mpox, syphilis, herpes simplex virus (HSV) and lymphogranuloma venereum
(LGV) through your usual pathology provider
• For further testing advice: https://sti.guidelines.org.au/sexually-transmissible-infections/monkeypox/
Advice to provide at the time of testing
• Abstain from sexual activity and close contact with others until their rash/lesions heal completely i.e. no
new lesions appear, scabs have fallen off, and new skin has formed, and any anal symptoms have
completely resolved
• Keep lesions covered with clothing or a dressing
• Provide the patient with the mpox fact sheet for cases: health.nsw.gov.au/mpox-cases
Encourage vaccination
• Mpox vaccination (JYNNEOS) consists of 2 d doses at least 4 weeks apart and is recommended for:
o all gay and bisexual men (cis and trans) and their sexual partners
o sex workers
o high-risk unvaccinated or partially vaccinated contacts, ideally within 4 days of exposure
• Vaccination is free. Find a vaccine clinic at health.nsw.gov.au/mpox-clinics
Further information
• Notify the local public health unit of suspected cases by calling 1300 066 055
• Contact your local sexual health clinic or call Sexual Health Info Link (SHIL) (1800 451 624
Monday to Friday 9am - 7pm) and select option 1 for health professionals
• For further information, see health.nsw.gov.au/mpox