Most people with mpox (monkeypox) recover with supportive care alone, meaning pain relief, wound care, and rest at home over two to four weeks. There is no FDA-approved antiviral specifically for mpox. For people with severe disease or at high risk for complications, an antiviral called tecovirimat is available through a special access program, though recent clinical trial data have raised serious questions about its effectiveness.
Supportive Care for Most Cases
If you have mpox without complications and are otherwise healthy, the core of treatment is managing symptoms while your immune system clears the virus. That means controlling pain, keeping lesions clean, staying hydrated, and resting. Most infections resolve on their own once all lesions scab over and a fresh layer of skin forms underneath, a process that typically takes two to four weeks.
Over-the-counter pain relievers like acetaminophen (Tylenol) and NSAIDs (ibuprofen, naproxen) are the first line for general discomfort, fever, and body aches. For localized pain around lesions, topical numbing agents like lidocaine cream or gel can help. If you have rectal lesions (proctitis), warm sitz baths with baking soda or Epsom salt can ease discomfort, and stool softeners reduce pain during bowel movements. In cases of severe pain that doesn’t respond to these measures, prescription options like gabapentin or short-term opioids have been used.
How to Care for Skin Lesions
Proper wound care reduces your risk of secondary bacterial infection, which is one of the more common complications. Keep lesions clean and dry. You can gently wash them with sterile water or an antiseptic solution, and when possible, leave them uncovered and exposed to air to promote healing. Wash your hands with soap and water or use hand sanitizer before and after touching any lesions. Avoid scratching, even when the itching is intense, since broken skin invites bacteria in.
Watch for signs that a lesion has become infected with bacteria: increasing redness, warmth, swelling, worsening pain, pus or foul-smelling drainage, or a return of fever after it had subsided. An infected lesion can develop into cellulitis or an abscess. Antibiotics are not recommended as a preventive measure for uncomplicated mpox, but they are necessary if a bacterial infection develops.
Tecovirimat: The Main Antiviral Option
Tecovirimat (brand name TPOXX) is an antiviral originally stockpiled for a potential smallpox emergency. It has been used to treat mpox under the CDC’s expanded access investigational drug protocol, meaning it is not FDA-approved for mpox and is only available through a formal request process for eligible patients. Those eligible generally include people with severe disease or at high risk for it.
The standard course is 14 days of oral capsules taken with a high-fat meal. An intravenous form exists for patients who cannot take pills or have gastrointestinal problems that would prevent absorption.
However, two major randomized clinical trials published results in 2024 that cast doubt on the drug’s effectiveness. The STOMP trial, published in the New England Journal of Medicine, enrolled 412 participants with clade II mpox. By day 29, 83% of those on tecovirimat and 84% of those on placebo had achieved clinical resolution of their skin lesions. There was no meaningful difference in pain reduction, lesion healing, or viral clearance between the two groups. These results held true across subgroups, including people who started treatment early (within three to five days of symptoms), people with HIV, and those previously vaccinated. A separate trial called PALM007, testing tecovirimat against clade I mpox, found the same lack of benefit.
Despite these findings, tecovirimat remains available through the CDC’s access program for high-risk patients, in part because options are limited and the drug’s safety profile is generally acceptable. But the evidence as it stands suggests it does not speed recovery for most people.
Who Qualifies for Antiviral Treatment
Antivirals are reserved for people with severe mpox or those at high risk for developing it. Severe disease includes situations like widespread confluent lesions, necrotic (dying) skin tissue, hemorrhagic disease, involvement of multiple organ systems (such as the lungs, brain, or heart), and eye infections near or involving the cornea. Conditions requiring hospitalization also fall into this category.
People considered high risk even without current severe symptoms include:
- People with advanced HIV, particularly those with very low immune cell counts or who are not on effective HIV treatment
- Organ transplant recipients and others on immunosuppressive medications
- People with skin conditions like eczema or atopic dermatitis that compromise skin integrity
- Children
- People who are pregnant or breastfeeding
For these groups, early consultation with the CDC or an infectious disease specialist is recommended. Combination therapy, adding a second antiviral to tecovirimat, may be considered in life-threatening cases or when the infection continues to worsen despite treatment.
Additional Antivirals for Severe Cases
When tecovirimat alone is not enough, or when a patient cannot receive it, two other antivirals can be used as add-on therapy. Cidofovir is given intravenously once a week and requires extra IV fluids and a companion medication to protect the kidneys from toxicity. Brincidofovir is an oral alternative given once a week for two doses. Neither drug is a first-line treatment, and both carry their own side effects, but they provide additional options for people with severe or worsening disease.
In rare cases where the immune system cannot mount an adequate antibody response, vaccinia immune globulin (VIGIV), a concentrated dose of antibodies, can be given intravenously as a single infusion. This is typically reserved for the most severely immunocompromised patients.
For people with advanced HIV, starting or optimizing antiretroviral therapy as soon as possible is a critical part of the treatment plan, since controlling HIV helps restore the immune response needed to fight mpox. People with severe immunosuppression may also need treatment courses longer than the standard 14 days if new lesions continue to appear or existing ones worsen.
Eye Involvement
Mpox can affect the eyes, and ocular infections are one of the more serious complications because they can threaten vision. If lesions develop on or near your eyelids, or if you experience eye redness, pain, or changes in vision, prompt evaluation by an ophthalmologist is important. An antiviral eye drop called trifluridine is recommended for cases involving the cornea and may be considered for conjunctivitis. Preventive use of these drops can also be appropriate for people with eyelid lesions, young children, or anyone who may have difficulty avoiding hand-to-eye contact.
Notably, steroid eye drops should be avoided. Evidence from related poxvirus infections suggests that topical steroids can allow the virus to persist in the eye and cause corneal damage. Lubricating drops and topical antibiotics may be added if a corneal ulcer develops, to prevent a bacterial infection on top of the viral one.
Vaccination After Exposure
If you’ve been exposed to someone with mpox but haven’t developed symptoms yet, the JYNNEOS vaccine can help prevent or reduce the severity of illness. It works best when given within four days of exposure. Vaccination between days 4 and 14 may still offer some protection, though it becomes less reliable the longer you wait. After 14 days, the decision is made on a case-by-case basis, but it can still be worthwhile for people at high risk, such as those with weakened immune systems.
Isolation and Recovery at Home
You remain infectious until every lesion has scabbed over, the scabs have fallen off, and a new layer of intact skin has formed. This typically takes two to four weeks, though it can take longer for people with many lesions or weakened immune systems. During this time, avoid close physical contact with others, especially skin-to-skin contact. Sleep in a separate bed, use separate towels and utensils, and clean shared surfaces regularly.
Contact your healthcare provider if your lesions are getting worse or multiplying, if you develop persistent fever, nausea, vomiting, decreased appetite, visual symptoms, difficulty breathing, or confusion. These can signal complications that may require more aggressive treatment or hospitalization.