Risky sexual behaviour fueling Mpox — Experts

I battled a high fever for six days, and just as it started to improve, I noticed a large, painful abscess in my private parts,” recalls Emily Nayebale, 27. 

A single mother of one, Nayebale first sought medical attention at a nearby clinic. Initially, health workers suspected syphilis and started treatment, but she did not respond. 

The rashes spread, covering her private parts and eventually her entire body, including the inside of her nose and throat. 

“My throat hurt so much that I could not eat or swallow. I could only drink water,” Nayebale recalls. 

She also experienced joint pain and the skin rash became intensely painful and itchy. 

On February 6, uncertain of the treatment she was receiving, Nayebale sought help at Hoima Hospital, where she was diagnosed with mpox and admitted to an isolation unit. 
Mpox, caused by the monkeypox virus, leads to painful rashes, swollen lymph nodes, and fever. Most patients recover fully, but some may die. 

Nayebale met others battling the same disease in the isolation unit. Thankfully, she responded well to the treatment: The rash dried up, and the body aches subsided. 

She was discharged on March 6, exactly one month after admission. While Nayebale does not disclose the source of her infection, she works as a hairdresser in Nalweyo, Kakumiro district. 

To avoid re-infection, health workers advised her to avoid risky sexual behaviours, shaking hands and sharing clothes or bedding. 

At the time of the interview, Nayebale was staying at her sister’s home in Buliisa district to avoid stigma and allow her large scars to heal before returning to Kakumiro. 

“The scars are large and cover my entire body. My biggest fear is how people back home will react,” she says. 

Inspired by her experience, Nayebale has begun sensitising communities about mpox. Recently, she identified a woman showing symptoms and advised her to seek treatment. 

Patrick Kafeero, another survivor, developed a high fever, headache and sore throat in early February. 

Initially thinking it was malaria, he went to the hospital, where tests for typhoid returned negative. A week later, Kafeero’s skin began itching and painful abscesses appeared on his private parts. 

Soon, similar abscesses spread to his scalp, palms, and feet. “The rash was painful and itchy and I scratched it, but it kept growing,” he says. 

Initially, Kafeero thought it was chickenpox and bathed in herbal concoctions while receiving ineffective injectable treatments from private clinics.

When the medication failed, Kafeero suspected he had HIV/AIDS. He hired a motorcycle to take him to a lab in Hoima city to test for HIV. 

Experts warn that condoms cannot prevent Mpox infection.

At the clinic, health workers quickly referred him to Hoima Hospital, where he was taken to the isolation unit.

Kafeero says he considered running away, until the man who brought him on a bodaboda persuaded him to stay and get treatment. Seeing other patients at the unit also gave him courage. 

He was discharged after two weeks with a follow-up schedule. Today, Kafeero, a truck driver in Hoima City, has fully recovered. Sadly, his wife and one child became infected with mpox. 

They received home-based care and are recovering well. Kafeero was advised to avoid risky sexual relationships. He now raises awareness about mpox and discourages men from engaging in sexual relationships with strangers.

Exposure to Mpox 

“Mpox remains a mysterious disease, often mistaken for chickenpox. It is a zoonotic disease found in wild animals like squirrels, rats, mice, and monkeys. It can spread to humans through bites, scratches, or activities such as hunting, skinning, trapping, and cooking,” Dr Bosa Henry Kyobe, the incident commander for mpox at the health ministry, says.

Kyobe further warns against eating wild meat, particularly from non-human primates, rodents, antelopes, gazelles, and tree squirrels, as these animals can carry the disease.

Intimate contact 

Dr Bernard Lubwama, the deputy incident commander for mpox, estimates that 70% of mpox infections in Uganda result from direct physical contact, especially sexual contact. 

Female commercial sex workers are particularly at risk, with many of their clients also being affected. Dr Nelson Wandera, a medical officer at the Highly Infectious Disease Unit at Mbarara Hospital, says over 50% of admitted female mpox patients are sex workers. 

At the Entebbe isolation unit, most Mpox patients admit to having contracted the disease after engaging in sexual activity with an untrusted person. 

Lubwama warns that condoms do not offer protection against mpox, as sexual contact involves skin-to-skin contact, including kissing and cuddling.

Mpox survivor Christine Kyokwijjuka shows her healing scars.

Clothes and bedding  

You risk contracting mpox if you share clothes and bedding with an infected person, warns Dr Kennedy Watumbe, the surveillance focal person at Entebbe Hospital. 

Watumbe advises caregivers to soak clothes and bedding in Jik and detergent for at least 30 minutes before washing. Afterwards, they should be hung in the sun to dry and iron to kill any germs. 

Emily Abigaba, the in-charge of the isolation unit at Hoima Hospital, says mpox can be transmitted from infected mothers to babies through breastfeeding or childbirth, especially if the mother has sores in the birth canal. The disease can also spread through amniotic fluid or blood.

Symptoms  
The incubation period for mpox is between five and 21 days. The skin rash typically appears at the site where the virus entered the body. For example, if contracted through sexual contact, the rash will appear in the genital area. 

In the first stage, patients experience symptoms such as headache, body aches, back pain, low energy, sore throat, and swollen lymph nodes. 

The rash usually follows a few days after fever and lymph node swelling, starting at the entry point and spreading to other areas such as the face, chest, arms and buttocks, as seen in Nayebale and Kafeero’s cases. 

Watumbe says mpox patients are less infectious once the skin rash has dried and the scabs have fallen off, allowing fresh skin to form. 

The rash can take two to four weeks to clear, during which time the individual remains infectious. 

Mpox can be difficult to identify because its symptoms overlap with other infections, such as chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis and other sexually transmitted diseases. 

Therefore, laboratory testing is required for confirmation.

Couples recovering from Mpox are advised to abstain until treatment is complete.

Treatment 

Mpox-infected individuals should be admitted to an isolation facility, where they are educated on the disease, and the potential risk of infecting others. 

Supportive care is given to manage symptoms, prevent complications and ensure proper nutrition to boost the immune system. 

Those with weakened immune systems, for example, people living with HIV, sickle cell disease and the elderly, are most at risk of death. This is why prompt medical treatment is vital.

Surface contamination 

Mpox can spread via respiratory droplets, contaminated objects like clothing or linen, and touching contaminated surfaces. 

Studies show the virus can last up to five days on dry surfaces such as stainless steel and glass, three days on plastic, and two days on wood, cardboard, or absorbent surfaces. 

Emily Abigaba, the in-charge of the isolation unit at Hoima Hospital, recommends regularly cleaning contaminated surfaces with soap and water or using an alcohol-based sanitiser.

Prevention tips 

🔴 Maintain good hygiene by regularly washing hands with soap and water, using an alcohol-based hand rub, and cleaning contaminated surfaces. 

🔴 Isolate if infected to prevent transmission to others. 

🔴 Do not share personal items such as towels, bedding, clothing, or sharp instruments. 

🔴 No sexual activity until rash clears. 

🔴 Avoid handshakes, hugging, kissing or pecking. 

🔴 Mpox spreads through sexual networks, so remain faithful to your spouse or partner.

Complications from mpox 

Dr. Kennedy Watumbe says mpox can cause severe damage to the genital area, with lesions growing larger and lasting longer. 

“We are seeing more patients with genital lesions,” he says. Watumbe is concerned that male survivors may experience erectile dysfunction, as the painful lesions could damage the nerves. 

“Erection is about nerve and blood supply,” he says. Watumbe emphasises the need for follow-up and counselling to ensure full recovery. Severe cases of mpox can lead to disfigurement from long-lasting scars. 

Doctors warn men who suffer from Mpox may suffer erectile dysfunction.

Dr Bosa Henry Kyobe, the mpox incident commander at the health ministry, says mpox can cause eye infections, which may appear up to 24 months later. 

It can also lead to secondary scalp infections and for pregnant women, affect the placenta and unborn child. Watumbe also highlights septics.