Monkeypox pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Bassel Almarie M.D.[2]


Monkeypox virus is a member of orthopoxvirus genus (family Poxviridae)[1]. The monkeypox virus genome consists of linear double-stranded DNA that multiplies in the cytoplasm of infected cell[2]. Possible routes of transmission are animal-to-animal, animal-to-human, and human-to-human. Virus is transmitted via direct contact with body fluids or lesions of infection person or animal, direct contact with contaminated materials such as clothing, and via respiratory secretions[3]. The role of vaginal fluids and semen in the transmission of the virus is still being investigated[4].


Animal-to-animal, animal-to-human, human-to-animal[5], and human-to-human are all possible routes to transmit the disease. Monkeypox can be transmitted by[3]

  • Direct contact with bodily fluids or sores on the body of someone who has monkeypox
  • Direct contact with contaminated materials such as clothing or linens
  • Respiratory secretions when people have close, face-to-face contact

A study showed that monkeypox virus was isolated from a person’s semen 6 days after symptoms appeared[6]. Other studies found that the DNA of the virus was present in semen weeks after infection[7][8][9][10]. However, the role of semen or vaginal fluids in the transmission remains unclear[4][11].


  • Monkeypox virus is a member of orthopoxvirus genus, which is a subdivision of Chordopoxvirinae that belongs to family Poxviridae[1].
  • It is a linear double-stranded DNA virus that multiplies in the cytoplasm of infected cell[2].
  • All the proteins required for viral DNA replication, transcription, virion assembly, and egress are encoded by the MPXV genome.
  • The genes encoding for housekeeping functions are present in the central region of the genome, and the genes encoding the virus–host interactions are located in the termini region[12].
  • The nucleotide sequence within the central region of the monkeypox virus genome is 96.3% identical with that of smallpox virus. Nonetheless, monkeypox virus is not the direct ancestor of smallpox virus and is unlikely to naturally acquire all properties of smallpox virus[13].


  1. 1.0 1.1 "ICTV".
  2. 2.0 2.1 Holland J, Domingo E (1998). "Origin and evolution of viruses". Virus Genes. 16 (1): 13–21. doi:10.1023/a:1007989407305. PMID 9562888.
  3. 3.0 3.1 "CDC Monkeypox Response: Transmission | CDC Online Newsroom | CDC".
  4. 4.0 4.1 "U.S. Monkeypox Outbreak 2022: Situation Summary | Monkeypox | Poxvirus | CDC".
  5. Seang S, Burrel S, Todesco E, Leducq V, Monsel G, Le Pluart D; et al. (2022). "Evidence of human-to-dog transmission of monkeypox virus". Lancet. doi:10.1016/S0140-6736(22)01487-8. PMID 35963267 Check |pmid= value (help).
  6. "Correction to Lancet Infect Dis 2022; published online July 15.". Lancet Infect Dis. 2022. doi:10.1016/S1473-3099(22)00511-4. PMC 9333949 Check |pmc= value (help). PMID 35908551 Check |pmid= value (help). External link in |title= (help)
  7. Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB; et al. (2022). "Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022". N Engl J Med. doi:10.1056/NEJMoa2207323. PMID 35866746 Check |pmid= value (help).
  8. Peiró-Mestres A, Fuertes I, Camprubí-Ferrer D, Marcos MÁ, Vilella A, Navarro M; et al. (2022). "Frequent detection of monkeypox virus DNA in saliva, semen, and other clinical samples from 12 patients, Barcelona, Spain, May to June 2022". Euro Surveill. 27 (28). doi:10.2807/1560-7917.ES.2022.27.28.2200503. PMC 9284919 Check |pmc= value (help). PMID 35837964 Check |pmid= value (help).
  9. Salam AP, Horby PW (2017). "The Breadth of Viruses in Human Semen". Emerg Infect Dis. 23 (11): 1922–1924. doi:10.3201/eid2311.171049. PMC 5652425. PMID 29048276.
  10. Antinori A, Mazzotta V, Vita S, Carletti F, Tacconi D, Lapini LE; et al. (2022). "Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022". Euro Surveill. 27 (22). doi:10.2807/1560-7917.ES.2022.27.22.2200421. PMC 9164671 Check |pmc= value (help). PMID 35656836 Check |pmid= value (help).
  11. "How It Spreads | Monkeypox | Poxvirus | CDC". Retrieved 2022-10-20.
  12. Alakunle E, Moens U, Nchinda G, Okeke MI (2020). "Monkeypox Virus in Nigeria: Infection Biology, Epidemiology, and Evolution". Viruses. 12 (11). doi:10.3390/v12111257. PMC 7694534 Check |pmc= value (help). PMID 33167496 Check |pmid= value (help).
  13. Shchelkunov SN, Totmenin AV, Babkin IV, Safronov PF, Ryazankina OI, Petrov NA; et al. (2001). "Human monkeypox and smallpox viruses: genomic comparison". FEBS Lett. 509 (1): 66–70. doi:10.1016/s0014-5793(01)03144-1. PMID 11734207.