Mpox (formerly called monkeypox) spreads primarily through close physical contact with an infected person. That includes skin-to-skin touch, kissing, sex, and even prolonged face-to-face conversation. A person with mpox becomes contagious four days before symptoms appear and stays contagious until every lesion has scabbed over, the scabs have fallen off, and fresh skin has formed underneath.
Skin-to-Skin and Sexual Contact
The most common way mpox spreads is direct contact with the skin lesions, rashes, or body fluids of someone who is infected. Touching, hugging, massaging, or having sex with an infected person all create opportunities for the virus to transfer. The sores themselves carry the highest concentration of virus, making any contact with open or healing lesions especially risky.
Sexual contact deserves special mention because it involves extensive skin-to-skin exposure. In the global outbreak that began in 2022 (caused by clade II of the virus), transmission has been almost exclusively linked to sexual contact, particularly among men who have sex with men. A newer outbreak of clade I, which started spreading from Central and Eastern Africa in 2024, also transmits through sexual contact but spreads more readily through everyday household contact and in healthcare settings as well.
Research from Italy found that close skin contact during sex, rather than semen itself, is the primary driver of sexual transmission. Viral DNA has been detected in semen for weeks after infection, but the actual infectiousness of semen appears to be low. Skin lesions, by contrast, consistently showed high levels of active virus regardless of viral load.
Mouth-to-Mouth and Respiratory Spread
Kissing is a direct transmission route because the virus can be present in saliva and on oral lesions. Beyond kissing, simply being face-to-face with an infected person, talking or breathing at close range, can generate respiratory particles that carry the virus.
Airborne spread over longer distances is less common but not impossible. Researchers have detected mpox virus DNA in air samples collected more than 1.5 meters (about 5 feet) from patient beds in hospitals, and in air at health centers in Spain. The virus tends to travel in relatively large respiratory droplets that fall to the ground quickly, so transmission generally requires sustained close proximity rather than brief passing contact. That said, under certain conditions like fast-moving, dry air, smaller particles carrying the virus can linger longer.
Contaminated Objects and Surfaces
You can also pick up mpox from objects an infected person has touched, though this is less common. Clothing, bedding, and towels pose more risk than hard surfaces like countertops or door handles. In a study of a household in Dallas, researchers found viable mpox virus on surfaces at least 15 days after contamination. Related viruses in the same family have remained detectable on fabrics for 28 to 70 days under favorable conditions.
The good news: viral levels on surfaces tend to be low, which limits the practical risk of catching mpox this way. Still, sharing bedding or clothing with someone who has active lesions is a real transmission route. Needle injuries in healthcare settings and community settings like tattoo parlors have also been documented as sources of infection.
Animal-to-Human Transmission
The virus originally jumped to humans from animals, which is how it got its name (it was first identified in laboratory monkeys in 1958). In parts of Central and West Africa, people can contract mpox through bites or scratches from infected animals, handling infected wildlife, or preparing bushmeat. Rodents, not monkeys, are thought to be the primary animal carriers. Outside of Africa, animal-to-human transmission is rare, and the vast majority of cases spread person to person.
Transmission During Pregnancy
Mpox can pass from a pregnant person to the fetus during pregnancy, or to a newborn through close contact during and after birth. Confirmed cases in endemic areas have resulted in miscarriage, stillbirth, and preterm delivery. Newborns who contract mpox are at higher risk of severe illness. It is currently unknown whether the virus is present in breast milk, but because mpox spreads through close contact, health authorities recommend separating an infected mother from her newborn and delaying breastfeeding until all lesions have fully healed.
When Someone Is Contagious
A person with mpox can spread the virus starting four days before their first symptom appears. This pre-symptomatic window is one reason the virus can be hard to contain: someone may not yet know they’re infected. Contagiousness continues through the full course of the rash, which typically progresses from flat spots to raised bumps to fluid-filled blisters to crusty scabs. The person is no longer considered infectious only after every scab has fallen off and a fresh layer of skin has formed, a process that can take two to four weeks.
How to Reduce Your Risk
Avoiding close physical contact with anyone who has a suspicious rash or confirmed mpox is the most effective form of prevention. If someone in your household is infected, avoid sharing bedding, towels, and clothing, and clean surfaces they’ve touched.
The JYNNEOS vaccine offers meaningful protection. A single dose reduces the risk of infection by roughly 35 to 86 percent depending on the study, while two doses bring effectiveness up to 66 to 90 percent. If you’ve been exposed to someone with mpox, getting vaccinated within four days offers the best chance of preventing infection. Vaccination between 4 and 14 days after exposure may still provide some benefit, though protection decreases the longer you wait.