A global case study series from 16 nations found that the most likely method of transmission in 95% of cases of monkeypox is sexual proximity. 

According to experts at Queen Mary University of London, the virus can spread through close personal contact through big respiratory droplets and possibly through clothing and other surfaces. The research team reported 528 cases detected at 43 sites across 16 nations between April 27 and June 24, 2022.

The results, which were reported in the New England Journal of Medicine (NEJM), revealed that 73% of people had anogenital lesions, 41% had mucosal lesions, and 95% of people had a rash (with 64% having less than 10 lesions) (with 54 having a single genital lesion). Overall, 75% of those with infection were white, 41% were HIV-positive, and 98% of those with infection were gay or bisexual men.

Fever (62%), fatigue (41%), myalgia (31%), and headache (27%), together with lymphadenopathy (swelling of the lymph nodes), were typical systemic symptoms that preceded the rash (reported in 56 per cent). Of the 377 people who underwent testing, 109 (29%) had concurrent sexually transmitted illnesses.

The median incubation period among the 23 individuals with a clear exposure history was 7 days. The DNA of the monkeypox virus was found in 29 out of 32 people whose seminal fluid was analysed.

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