Information for Providers:
The prognosis for mpox depends on multiple factors, such as mpox vaccination status, initial health status, concurrent illnesses, and comorbidities among others. Supportive care and treatment of symptoms should be initiated for all patients who have mpox infection. This may include different topical, systemic medications, or other clinical interventions to control pain, itching, nausea and vomiting. Proctitis can occur and progress to become severe and debilitating, that may require prescription medication.
- Patients with pruritis, consider: Calamine lotion, petroleum jelly, menthol lotion, or camphor lotion.
- If uncontrolled pruritis despite topical therapy: Consider antihistamines (e.g. loratadine).
- Anticipatory guidance for patients:
- Keep the area clean and dry when not bathing to prevent bacterial infections.
- Seek care if pain increases or they observe any pain, redness, swelling, or cloudy fluid at the site of the rash.
- Saltwater rinses 4 times daily.
- Consider chlorhexidine mouthwash to keep the lesions clean. Alcohol-free mouthwash (e.g. Listerine Zero Alcohol) can also be used to keep the lesions clean.
- Magic/Miracle Mouthwash can be prescribed if significant oral pain.
- Consider oral lidocaine gels if significant pain that makes eating difficult. These should be limited to recommended dosages.
Painful genital and anorectal lesions, proctitis
Warm sitz baths lasting 10 minutes several times a day.
Topical lidocaine gels or creams (at recommended dosages)
Stool softeners should be prescribed early
If pain is not improving with OTC medications (e.g. acetaminophen and ibuprofen) and with topical remedies mentioned above, consider prescription medications (such as gabapentin or opioids.) If prescribing opioid medications, note the possibility of side effects such as constipation. Consider corticosteroid/local anesthetic (e.g. hydrocortisone/lidocaine) gels/creams
Anticipatory guidance for patients:
Seek care if blood in the urine, difficult urinating, inability to retract foreskin (or foreskin cannot return to normal position after retracting), rectal bleeding.
Nausea and Vomiting, dyspepsia
Trifluridine is a topical antiviral medication that can be used for ocular complications of mpox.
For lesions near the eye or eyelid lesions, there is still a risk for autoinoculation, prophylactic Trifluridine drops along with Tecovirimat therapy should be considered.
Nutrition and Hydration
Mental Health Considerations