Mpox in 2026: What Gay and Bi Men Need to Know Now

Mpox has not gone away. The virus, formerly known as monkeypox, is still spreading in Europe and beyond. Gay and bisexual men remain the group most affected. New data from the European Centre for Disease Prevention and Control (ECDC) shows that case numbers rose again in several countries in 2025. Health services now urge men at higher risk to check their vaccination status.

This article explains what mpox is, who should get vaccinated, and what to do if you notice symptoms. The goal is practical: clear facts, no panic.

What is mpox and why does it matter now?

Mpox is a viral infection caused by the monkeypox virus. It is related to smallpox but milder. The disease causes a rash, blisters and flu-like symptoms. Most people recover within two to four weeks. In rare cases the illness becomes serious, especially in people with weakened immune systems.

The big global outbreak started in May 2022. Within a year, more than 90,000 cases were reported in over 110 countries, according to the World Health Organization (WHO). The outbreak mostly spread through sexual networks of men who have sex with men. The WHO declared a public health emergency in 2022, ended it in 2023, and declared a new emergency in August 2024 because of a different, more severe variant (clade I) spreading in Central Africa.

In Europe, clade II remains the most common form. But the ECDC has confirmed several clade I cases since 2024 in travellers and their contacts. The agency calls the risk for the general public low, but moderate for men with multiple sexual partners.

How does mpox spread?

Mpox spreads mainly through close skin-to-skin contact. Sex is one of the most common routes, but not the only one. The virus can also pass through:

• Kissing and intimate contact
• Shared bedding, towels or sex toys
• Respiratory droplets during prolonged face-to-face contact
• Contact with the rash or scabs of an infected person

Mpox is not classed as a typical sexually transmitted infection, but sexual contact is the main driver in current outbreaks. Condoms reduce risk but do not fully prevent transmission, because the rash can appear anywhere on the body.

Symptoms: what to look for

The first signs often look like the flu. People report fever, headache, muscle pain, tiredness and swollen lymph nodes. Within one to four days a rash appears. The rash often starts in the genital or anal area, the mouth, or the face.

The spots turn into blisters, then scabs. They can be very painful, especially around the anus or in the throat. Some people only get a few spots. Others develop dozens. The incubation period is usually 5 to 21 days after exposure.

If you notice unusual spots, sores or blisters, contact your GP or a sexual health clinic. Do not have sex until you have a diagnosis. In the Netherlands, the GGD offers free testing and advice.

The vaccine: who should get it?

The MVA-BN vaccine (sold as Jynneos, Imvanex or Imvamune) is the main tool against mpox. It is given in two doses, four weeks apart. Studies published in The Lancet and the New England Journal of Medicine in 2023 and 2024 found that two doses reduce the risk of symptomatic mpox by around 66 to 86 percent. One dose offers partial protection.

In the Netherlands, the RIVM and GGD offer free mpox vaccination to:

• Men who have sex with men and use or are eligible for PrEP
• HIV-positive men who have sex with men with recent STI history
• Sex workers in higher-risk settings
• People who had close contact with a confirmed case

Similar programmes run in Germany, the UK, Belgium and France. If you were vaccinated in 2022 or 2023, current advice is that you do not need a booster unless you are immunocompromised. The ECDC reviews this guidance regularly.

What if you get mpox?

Most cases are mild and clear up without specific treatment. Painkillers, fluids and rest help. Doctors may prescribe stronger medication for severe pain or secondary infections. The antiviral tecovirimat was widely hoped to shorten illness, but a large trial published in 2024 by the US National Institutes of Health found it did not reduce symptom duration in most patients. Research continues.

If you test positive, isolate at home until all scabs have fallen off and new skin has formed. This usually takes two to four weeks. Tell recent sexual partners so they can monitor for symptoms or get tested.

Mpox and HIV: a special note

People living with HIV who have well-controlled viral loads usually recover from mpox like anyone else. But people with advanced HIV (CD4 count below 200) face a much higher risk of severe disease and death. A 2023 study in The Lancet found mortality of around 15 percent in this group. Regular HIV testing and treatment matter more than ever. Researchers also continue to work on long-term protection, including the search for an HIV vaccine.

Stigma and testing

Aidsfonds and other organisations warn that stigma still stops people from getting tested. Mpox is not a "gay disease" — anyone can get it. But because the virus spreads through close contact, sexual networks remain a key route. Honest conversations with partners and clinics save time and prevent further spread.

Sexual health clinics in most European cities offer combined testing for mpox, HIV and other STIs. Many also vaccinate on the same visit. For broader context on how LGBTQ+ health policies are shifting, see our overview of 7 countries where LGBTQ+ rights are changing fast in 2026.

Practical takeaway

Mpox is manageable but still active. Three steps reduce your risk:

1. Check whether you are eligible for free vaccination at your local GGD or sexual health clinic.
2. Know the symptoms. Any new rash, blister or sore deserves a check-up.
3. Talk openly with partners. Early testing protects you and others.

Vaccination remains the strongest defence. The ECDC and WHO continue to track outbreaks and update advice. For up-to-date information in your country, check national health agencies such as RIVM (Netherlands), RKI (Germany) or UKHSA (United Kingdom).