Health officials have alerted gay and bi men, in particular, to be on the lookout for unusual rashes. However, healthcare providers should be alert to any rash that has features typical of monkeypox," Inger Damon, MD, PhD, director of the Division of High-Consequence Pathogens and Pathology, said in a May 18 statement. “Many of these global reports of monkeypox cases are occurring within sexual networks. McQuiston added that close personal contact can include household members and health care workers, “but not passing a person in a grocery store.” She noted that transmission is most likely when a person is symptomatic respiratory transmission is thought to occur when an individual has monkeypox lesions in their mouth or throat. “Monkeypox is not a sexually transmitted infection in the typical sense, but it can be transmitted during sexual and intimate contact,” CDC epidemiologist John Brooks, MD, said during the media briefing. Experts have historically thought that monkeypox is not easily transmitted between humans, and it is not yet clear why it is now spreading more extensively.
The virus can enter the body through the respiratory tract, broken skin or mucous membranes, according to the CDC. It is not known whether it is directly transmitted through semen. The monkeypox virus is transmitted through close personal contact, including skin-to-skin contact, kissing, contact with clothes or bedding and respiratory droplets, but it does not appear to spread through the air like SARS-CoV-2. The virus has an incubation period of up to three weeks before symptoms start, and the illness typically lasts two to four weeks. The rash, which can be flat, raised, or pus-filled, may resemble other conditions including herpes, syphilis or chickenpox. Monkeypox, which is related to smallpox but less severe, typically causes flu-like symptoms (fever, fatigue, muscle aches), swollen lymph nodes and a rash that can occur on the face, genitals, palms of the hands, soles of the feet and elsewhere on the body.
The latest two cases (same household) are not linked to the previous confirmed case announced on 7 May. Keeping a close eye of the latest updates from on Monkeypox cases confirmed in England. (Local testing can show that a person has a virus in the orthopox family, but further testing at the CDC is needed to confirm a monkeypox diagnosis.) All are men with a recent history of international travel. Jennifer McQuiston, DVM, deputy director of the CDC’s Division of High-Consequence Pathogens and Pathology, said during a May 23 media briefing.
In the U.S., the CDC has confirmed one case in Boston, with four more presumptive cases in New York City, south Florida and Salt Lake City, Capt. Several cases are reported to be linked to a sauna in Spain and events including a fetish festival in Belgium. Many of the men identify as gay or bisexual or were seen at sexual health clinics. Worldwide, all but one of the more than 250 confirmed or suspected cases compiled by Global.health with a known age and sex are young or middle-aged men one woman in Spain is a suspected case. A large number of confirmed cases have also been reported in Spain, Portugal and Canada, with smaller numbers in several other European countries, Australia and Israel. As of May 23, UKHSA had reported 56 confirmed cases. This was soon followed by two additional cases who share a household and four cases among gay and bi men, all of whom appear to have contracted the virus locally. Health Security Agency (UKHSA) reported the first case in the current outbreak on May 7, a man who had recently traveled to Nigeria, where monkeypox is endemic. The new cases have so far been mild, with no deaths reported. Experts stress that monkeypox does not spread as easily as SARS-CoV-2, the virus that causes COVID-19, and they do not expect a pandemic of that scale. Nonetheless, others should be aware that they, too, could be at risk. So far, these cases have “mainly but not exclusively been identified amongst men who have sex with men,” according to the WHO. The Centers for Disease Control and Prevention (CDC) is investigating five monkeypox cases in the United States, while the World Health Organization (WHO) has now confirmed 92 cases in around a dozen countries.
Editor’s note: This article was originally published on May 19 and has been updated to incorporate new information.