Mpox, formerly known as monkeypox, is a viral illness that requires careful management to help patients recover safely and prevent spread to others. While most people recover with supportive care alone, understanding the available treatment options, preventive measures, and emerging therapies tested in clinical trials can help patients and caregivers make informed decisions during the course of this illness.

Understanding How Mpox is Managed: Goals and Approaches

The main goal when treating mpox is to help patients feel better while their body fights off the infection, and to prevent complications that could arise during the illness. Because mpox is caused by a virus, treatment focuses on managing symptoms such as pain, fever, and the characteristic skin rash that develops during infection. Most people with mpox will recover on their own within two to four weeks without needing specialized medicines, though the journey can be uncomfortable and requires careful attention to self-care and isolation measures to protect others.

The approach to managing mpox depends on several factors. Healthcare providers consider how severe the illness is, whether the patient has any underlying health conditions that might make the infection more dangerous, and what symptoms need the most attention. Some people experience only mild discomfort and can recover at home with basic care, while others may develop more serious complications that require medical supervision or even hospitalization. People with weakened immune systems, pregnant women, young children under eight years of age, and those with skin conditions like eczema face higher risks and may need more intensive monitoring or treatment.

Standard treatments approved by medical societies focus on what is called supportive care, which means helping the body heal itself by managing symptoms and preventing complications. At the same time, researchers around the world are studying new antiviral medicines and other therapies in clinical trials, hoping to find treatments that can specifically fight the monkeypox virus and speed recovery, particularly for patients at risk of severe disease.

Standard Treatment: Supporting the Body’s Natural Healing

For most people diagnosed with mpox, treatment does not involve any special antiviral medications. Instead, healthcare providers recommend supportive care, which focuses on keeping patients comfortable while their immune system does the work of clearing the infection. This approach has proven effective for the majority of cases, especially those involving healthy adults without underlying immune problems.

Pain management is often the most important part of supportive care. The rash that develops with mpox can be extremely painful, particularly when lesions appear in sensitive areas such as the genitals, anus, mouth, or throat. Over-the-counter pain relievers like ibuprofen (found in brands like Advil or Motrin) and acetaminophen (Tylenol) can help reduce both pain and fever. These medicines work by reducing inflammation and blocking pain signals in the body. In cases where pain becomes severe and difficult to manage at home, doctors may prescribe stronger pain medications to help patients cope with the discomfort.

Taking care of the skin rash requires gentle attention and good hygiene practices. Patients are advised not to touch, scratch, or try to pop the blisters, as this can spread the virus to other parts of the body or cause bacterial infections in the open sores. Keeping the rash clean and dry helps prevent these secondary infections, which can complicate recovery. For itching, doctors may recommend oral antihistamines like Benadryl, or topical creams such as calamine lotion or petroleum jelly to soothe the skin. Some patients find relief from soaking in warm baths with oatmeal-based products, which can calm irritated skin.

When lesions appear around the anus or genitals, a sitz bath can provide comfort. This involves sitting in shallow warm water, sometimes with added ingredients like Epsom salt or medications prescribed by a healthcare provider. The warm water helps soothe painful areas and keeps them clean. For mouth sores that make eating and drinking painful, patients might use topical numbing gels containing benzocaine or lidocaine to temporarily relieve pain before meals.

Staying well-hydrated and maintaining good nutrition are crucial during recovery. Fever and reduced appetite can leave patients dehydrated and weak, so drinking plenty of water and eating nutritious foods when possible helps the body maintain its strength. Getting adequate rest allows the immune system to work more effectively against the virus.

The duration of supportive care continues until all symptoms resolve. Patients remain infectious from the moment symptoms begin until every scab has fallen off and a fresh layer of intact skin has formed underneath. This means isolation and careful hygiene must be maintained throughout the entire illness, which typically lasts two to four weeks. Most patients gradually feel better as the rash progresses through its stages, moving from flat red spots to raised bumps, then to fluid-filled blisters, pus-filled pustules, and finally to scabs that eventually heal.

Treatment in Clinical Trials: Exploring New Options

While supportive care works well for most mpox cases, researchers have been actively studying antiviral medications that might help patients who develop severe illness or who are at high risk for complications. These investigations focus on drugs that were originally developed to treat other viral infections, particularly smallpox, which is caused by a related virus in the same Orthopoxvirus family. Because these viruses share similarities, scientists hope that medicines effective against smallpox might also work against the monkeypox virus.

The most extensively studied treatment in clinical trials is an antiviral drug called tecovirimat, also known by its brand name TPOXX or code name ST-246. This medication works by blocking a specific protein that the virus needs to spread from one cell to another in the body. In laboratory studies and animal testing, tecovirimat showed promising results in preventing death from lethal poxvirus infections. Based on this animal data, the drug was approved by the FDA for treating smallpox, though it had never been widely tested in humans with active poxvirus infections until the global mpox outbreak that began in 2022.

During that outbreak, tecovirimat became available through a special program called an Expanded Access Investigational New Drug protocol. This allowed doctors to prescribe the medicine to patients with severe mpox or those at high risk of complications, even though its effectiveness in humans with mpox had not yet been proven. The medication can be taken as pills or given through an injection, and for young children who cannot swallow pills, the capsules can be opened and mixed with semi-solid food.

Two major clinical trials were launched to properly evaluate whether tecovirimat actually helps people with mpox. The PALM007 trial and the STOMP trial, both sponsored by the National Institute of Allergy and Infectious Diseases, enrolled patients with mpox and randomly assigned them to receive either tecovirimat or a placebo (an inactive substance). These were Phase III trials, which means they were designed to compare the new treatment directly against standard care in a large group of patients. The trials took place in several countries, including sites in the Democratic Republic of Congo and other regions where mpox was spreading.

The results from these trials, released in 2024, were surprising and somewhat disappointing. While tecovirimat proved to be safe with few serious side effects, the studies showed that it did not significantly shorten the time it took for mpox lesions to heal compared to patients who received only supportive care. In other words, patients who took tecovirimat recovered at about the same speed as those who did not receive the antiviral. This finding challenged the initial hope that tecovirimat would provide clear benefits for most people with mpox.

Despite these results, tecovirimat remains available for certain high-risk patient groups. Healthcare providers may still consider using it for patients who are severely immunocompromised, such as people with advanced HIV infection, those who have received organ transplants, or patients with severe skin conditions that could allow the virus to spread uncontrollably. The reasoning is that while the drug may not help most people recover faster, it might still offer some benefit for those facing life-threatening complications, even if this benefit has not been definitively proven in clinical trials.

Another antiviral being studied is cidofovir, which works by interfering with viral DNA replication. This medication has shown activity against poxviruses in laboratory studies and animal models. However, cidofovir is primarily used to treat a different infection called cytomegalovirus, and it can cause serious side effects, particularly kidney damage. Because of these risks, cidofovir is generally reserved only for the most severe cases of mpox, and it too is available through special access programs rather than as a standard treatment. The CDC holds an Expanded Access IND for cidofovir that allows its use during mpox outbreaks.

A newer medication called brincidofovir (brand name Tembexa) is a modified version of cidofovir designed to have fewer side effects, especially on the kidneys. Brincidofovir is a prodrug, meaning it converts into the active drug cidofovir inside the body’s cells. It is approved for treating smallpox and may have an improved safety profile compared to regular cidofovir. The CDC is developing protocols to make brincidofovir available for treating mpox patients who might benefit from antiviral therapy. This medication represents an innovative approach to delivering antiviral effects while minimizing the harmful side effects that limited the use of the original drug.

Another treatment option studied in severe cases is Vaccinia Immune Globulin, or VIG. This is not an antiviral drug but rather a blood product containing antibodies from people who have been vaccinated against smallpox. The idea is that these antibodies might help fight the monkeypox virus in patients whose own immune systems are struggling to control the infection. However, data on VIG’s effectiveness specifically for mpox complications is limited, and it is available only through special access programs during outbreaks.

All of these experimental treatments are stockpiled by the U.S. government in the Strategic National Stockpile, a repository of medicines and supplies maintained for use during public health emergencies. During an outbreak, healthcare providers must work with their local public health departments and the CDC to request access to these medications for eligible patients. The process has been streamlined to allow treatment to begin quickly, especially when patients are severely ill, though paperwork and reporting requirements still apply to track how well the medicines work and identify any side effects.

Research continues into other potential therapies. Scientists are exploring whether other antiviral drugs developed for different diseases might have activity against the monkeypox virus. Additionally, studies are examining the best ways to care for specific complications, such as severe pain from rectal lesions, inflammation of the heart muscle (myopericarditis), or infections of the eye that could threaten vision. For eye complications, antiviral eye drops containing drugs like trifluridine are being investigated, though data on their effectiveness remains limited.

The clinical trial landscape for mpox is evolving as researchers learn more about the disease. Future studies may focus on combination therapies that use multiple drugs together, or on treatments specifically designed for pregnant women, infants, and people with particular underlying conditions. The goal is to identify which patients truly benefit from antiviral therapy and which interventions can prevent the most serious outcomes.

Most common treatment methods

• Supportive care and symptom management
  • Over-the-counter pain relievers like ibuprofen and acetaminophen to reduce fever and pain
  • Topical treatments including calamine lotion, petroleum jelly, and benzocaine or lidocaine gels for rash relief
  • Antihistamines such as Benadryl to help with itching
  • Warm baths with oatmeal products or Epsom salt for skin comfort
  • Sitz baths for lesions around the anus or genitals
  • Adequate hydration and nutrition to support the immune system
  • Rest and isolation until all scabs have healed completely
• Antiviral medications (available through special access programs)
  • Tecovirimat (TPOXX, ST-246) blocks viral spread between cells; available as pills or injection; studied in Phase III clinical trials but did not significantly reduce healing time in most patients
  • Cidofovir interferes with viral DNA replication; reserved for severe cases due to kidney toxicity risks
  • Brincidofovir (Tembexa) is a modified form of cidofovir with potentially fewer side effects; approved for smallpox treatment
• Immune-based therapy
  • Vaccinia Immune Globulin (VIG) provides antibodies from smallpox-vaccinated donors; used in severe cases with limited data on effectiveness
• Prevention through vaccination
  • Smallpox vaccines shown to be up to 85% effective against mpox
  • Post-exposure vaccination (ring vaccination) may help prevent or reduce severity if given soon after exposure
  • Recommended for high-risk individuals and close contacts of confirmed cases