Gay and bisexual men are being urged to be alert to unusual rashes or lesions after four new cases of the monkeypox virus were confirmed by UK health authorities, taking the total number of infections in the country to seven since the first case emerged earlier this year.
The UK Health Security Agency (UKHSA) said on Monday evening that all of the new cases, three in London and one in the north east of England, self-identify as gay, bisexual or other men who have sex with men (MSM).
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There is no link to travel to a country where monkeypox is endemic, and exactly where and how they acquired their infections remains under "urgent investigation", including whether they have further links to each other, it said.
"We are particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay," said Dr Susan Hopkins, UKHSA Chief Medical Adviser.
"This is rare and unusual. UKHSA is rapidly investigating the source of these infections because the evidence suggests that there may be transmission of the monkeypox virus in the community, spread by close contact," she said, adding that potential close contacts of the seven known cases are being contacted to provide health information and advice.
Currently, common contacts between the cases have been identified for two of the four latest cases. Those patients needing medical care are all in specialist infectious disease units at the Royal Free Hospital, Royal Victoria Infirmary in Newcastle upon Tyne and Guys' and St. Thomas' in London.
The UKHSA said they all have the West African clade of the virus, which is mild compared to the Central African clade.
"Due to the recent increase in cases and uncertainties around where some of these individuals acquired their infection, we are working closely with NHS [National Health Service] partners to identify if there may have been more cases in recent weeks, as well as international partners to understand if similar rises have been seen in other countries," the health agency said.
Monkeypox is a viral infection usually associated with travel to West Africa. It is usually a mild self-limiting illness, spread by very close contact with someone with monkeypox and most people recover within a few weeks.
"The virus does not spread easily between people and the risk to the UK population is low. However, the most recent cases are in gay, bisexual and other MSM communities, and as the virus spreads through close contact, we are advising these groups to be alert to any unusual rashes or lesions on any part of their body, especially their genitalia, and to contact a sexual health service if they have concerns," the UKHSA said.
The health authorities are urging anyone with concerns that they could be infected with monkeypox to make contact with clinics ahead of their visit, reiterating that their discussion will be treated sensitively and confidentially.
"Clinicians should be alert to individuals presenting with rashes without a clear alternative diagnosis and should contact specialist services for advice," the agency said. Initial symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.
A rash can develop, often beginning on the face, then spreading to other parts of the body including the genitals. The rash changes and goes through different stages, and can look like chickenpox or syphilis, before finally forming a scab, which later falls off.