Can monkeypox spread on the subway? Can it kill like COVID-19? Is it transmitted through sex?

Misconceptions, myths and a lack of public knowledge on the monkeypox virus are widespread. Despite 57 percent of adults recently polled by Morning Consult feeling confident in the Centers for Disease Control and Prevention’s ability to control the spread of monkeypox, many Americans are misinformed on how the virus spreads and how concerned they should be

Last month, the Annenberg Public Policy Center found that nearly half of 1,580 surveyed adults were not sure if monkeypox was less contagious than COVID-19. (It is much less contagious.) One-third of more than 4,000 adults polled by Morning Consult aren’t sure how monkeypox spreads. Two-thirds of those surveyed by Annenberg were unsure or didn’t believe that there is a monkeypox vaccine (there is, it’s FDA-approved, and to be eligible for a vaccine right now in most areas, people must be in a high-risk group — predominately queer men, or trans and nonbinary people, who have had multiple or anonymous sex partners in the last two weeks). 

Monkeypox is a disease primarily transmitted through skin-to-skin contact that can infect anyone, but is currently affecting queer men the most.

Here’s what experts have to say in response to common misconceptions and myths about the monkeypox virus. 

People can get monkeypox on public transit, in dressing rooms, or while shopping: False 

The risk of getting infected through these situations is extremely low, said Stephen Abbott, medical director at Whitman-Walker’s Max Robinson Center, a D.C.-based health care provider focused on serving LGBTQ+ people.

Abbott stressed that spread occurs through direct skin-to-skin transmission — not skin-to-object, then someone else touching that object. The virus can spread by touching sex toys, sheets and other fabrics that have made contact with exposed lesions or skin rashes, per the CDC — but the vast majority of cases are being reported by men who had sex or close intimate contact with another man prior to infection.

Places where a person could typically pick up a cold or flu virus are not considered primary points of transmission.

“There’s really no evidence at this time to suggest people are being infected through casual contact through public transportation, and anything like that. The vast majority of the cases that have been identified from the outbreak so far had been through intimate contact or sexual activity,” said Daniel Uslan, co-chief infection prevention officer at UCLA Health and clinical chief of infectious diseases.

Monkeypox can spread through shaking hands or hugging: Not likely  

These are also very low-risk situations, Uslan said, adding that he is not aware of recorded cases where handshaking is the suspected route of transmission. 

But skin-to-skin contact with someone who has an open lesion can still occur if those lesions are on the hands, Abbott noted — and some lesions are so small that patients don’t notice them. 

“Some of the patients I’ve seen when I do their skin exam, they haven’t even noticed that they have a lesion on their hand,” he said. “They might inadvertently shake someone’s hand and expose them unknowingly.” 

However, some of the fears surrounding the spread of monkeypox — especially from low-risk encounters in public spaces — seem to manifest from anti-LGBTQ+ sentiment, as gay and bisexual men are primarily contracting the virus right now, said Perry Halkitis, dean and professor of public health and health equity at Rutgers School of Public Health. 

“People will use any piece of information, if they are homophobic, to disadvantage and to stigmatize gay men,” he said. 

Monkeypox is an STD or STI: False, but sexual contact is still driving the spread.

The virus can spread through any prolonged skin-to-skin contact with lesions or rash areas — but transmission during sex, where plenty of skin-to-skin contact takes place, is still primarily how the virus is spreading right now. 

“You can have sex with somebody and have the flu, and they can get the flu. That doesn’t make the flu an STI,” Halkitis said. Oral, anal, or vaginal intercourse are not required for monkeypox transmission to occur, he added. 

“Technically, it is not [an STD or STI] because it is not solely spread through sexual contact. But the current outbreak appears to be spreading primarily through sexual contact, so it is associated with sex, but is not technically a sexually transmitted infection,” Uslan said. 

Abbott agreed that, by definition, monkeypox is not an STI or STD. Josh Michaud, associate director of global health policy at the Kaiser Family Foundation, noted that the answer should ultimately not affect how the country responds to the virus — and that labeling the virus as an STI may not be black or white. 

“What we know is that sexual behavior, or particularly men who have sex with men with multiple partners, has been the bulk of the cases so far of monkeypox. And therefore transmission is very much associated with sexual activity,” Michaud said. “I think people are sort of debating terminology here. And we don’t necessarily need to classify it to be able to respond to it one way or the other.”

Having chickenpox or shingles protects someone from monkeypox: False  

The virus that causes chickenpox is unrelated to monkeypox, although their names are similar. 

“The viruses are in completely different families,” said Michaud. “In the case of the chickenpox virus, it doesn’t provide any cross-protection against monkeypox.” 

Getting the smallpox vaccine as a kid protects against monkeypox: Likely 

Someone who got the smallpox vaccine as a kid would likely have some protection against current monkeypox transmission, experts say, since the viruses are in the same family. However, any immunity provided by a childhood smallpox shot may have waned.

“Health departments are still suggesting that those folks get vaccinated,” Abbott said, adding that immunity may have waned because smallpox was declared eradicated in 1980. 

The passage of several decades since smallpox vaccinations were commonplace means that most young people have not received the same level of protection, Uslan noted. 

Monkeypox is as contagious, or as dangerous, as COVID-19: False 

Monkeypox is not as contagious, or as fatal, as COVID-19, which is highly transmissible through airborne and respiratory routes. 

“It is absolutely not as contagious as COVID,” Uslan said. Monkeypox is not spreading through casual contact, and evidence so far shows that patients are not contagious with monkeypox until symptoms emerge — as opposed to COVID-19, which asymptomatic people can spread. 

“It’s also not nearly as fatal,” Abbott said, and it won’t leave you with a chronic infection. “It’s a rash that is very uncomfortable and painful. But most people will recover in two to four weeks.” 

While scarring can be one long-term side effect, after the lesions heal, there haven’t been reports of a “long” monkeypox syndrome similar to the long COVID that many Americans have experienced. 

People are at higher risk of contracting monkeypox if they’ve had COVID-19 before: False  

There is no evidence to suggest that getting COVID-19 increases a person’s risk to contract monkeypox. While those who are immunocompromised are more susceptible to contract a variety of viruses, Halkitis noted, contracting COVID does not mean someone is more likely to get monkeypox. 

“With two different diseases, one doesn’t create exposure to the other,” Abbott said.

Children are at risk of getting monkeypox right now: False  

Children are still at minimal risk. While the virus could spread into their social networks at some point, the current focus to slow the spread of the virus is to vaccinate men who have sex with men.

“I don’t think parents should be terribly worried at this time, but this is something that people should be paying attention to,” Uslan said. “We have not seen a lot of cases in daycare settings for children at this point. So it doesn’t seem to be a major concern.” 

While a few monkeypox cases have been seen in women and children, and the potential for greater spread cannot be ignored, the difference in risk right now is still massive, Michaud said.

Everyone is at the same risk of getting infected right now: False  

A person’s risk of getting infected with monkeypox is high right now if they are among high-risk groups like queer men who have recently had multiple sexual partners or anonymous sex, or aren’t using protection. 

“If we’re gonna get ahead of this and keep it from escalating, we need to be vaccinating those at highest risk — gay and bisexual men and our networks, and trans folks as well,” Abbott said, noting that social networks within these groups can be vectors for spread alongside sexual networks. 

“The highest-risk individuals in my view are young gay and bisexual men, born after 1972, who have no smallpox vaccination, and who are socializing in large groups with other gay men,” Halkitis said. 

It’s not safe for people with eczema to get the JYNNEOS vaccine shot: False 

It’s safe to get the JYNNEOS shot even with eczema or similar skin conditions. However, ACAM2000, an FDA-licensed smallpox vaccine that may also be effective against monkeypox but is not being widely offered due to a long list of side effects and a more difficult injection procedure, can be harmful to those with eczema and those with other exfoliative skin conditions or dermatitis. 

TPOXX treatment is not safe for people living with HIV: False 

TPOXX, the antiviral and primary pain management treatment for monkeypox, is safe for those living with HIV, including those taking antiviral drugs to manage their HIV, experts said. There are also no interactions between the JYNNEOS vaccine and HIV medications, Halkitis said. 

More studies on TPOXX’s effectiveness are gearing up and are likely to start in the next few weeks, Uslan said, although it is already known that the treatment is safe and well-tolerated in healthy patients. 

According to an analysis by the CDC of monkeypox cases from May through July, a substantial number of monkeypox cases have been reported among those with HIV. 

Find more information on monkeypox symptoms, how the virus spreads, and what to do if you are sick from the CDC’s website.