The number of monkeypox cases reported around the world has surpassed 400, and people are understandably worried about this — especially since we’re likely only detecting a fraction of the real cases. Given what the world went through with COVID-19, the prospect of yet another disease striking from the shadows is indeed spooky, but this is unlikely to degenerate into another pandemic.

Contrary to some information floating around it’s also not a sexually transmitted infection (STI), and it’s most definitely not a “gay disease”.

Monkeypox, as the name implies, is a disease related to smallpox that originated in monkeys. It’s not a new disease (it’s been around for decades), and it has caused small, localized outbreaks several times in Central and West Africa. But this time it’s different.

This time, the virus has already spread to some two dozen countries on virtually all continents, and it’s not even clear whether the virus is the same as the previous strains or if there’s anything unusual about it. There are two endemic strains, one milder and one more severe, and the symptoms in this 2022 outbreak seem to be milder.

Monkeypox patients commonly develop flu-like symptoms and, after a few more days, a rash resembling that of chickenpox or smallpox. But some of these new cases seem somewhat unusual, which could be a sign of concern.

“That’s what’s a bit mysterious about this and why they are doing all this genetic sequencing to see if there’s something unique about this particular strain of the virus,” David Freedman, president-elect of the American Society of Tropical Medicine and Hygiene, told Axios. It will take a few more weeks to know for sure.

In the meantime, while this is clearly a concerning outbreak, the virus isn’t exactly behaving in an unexpected way, and there’s a good chance things can be yet brought under control. The “larger risk to the overall community is extraordinarily low” the CDC’s poxvirus epidemiology team lead, Andrea McCollum added for Axios.

An important difference is that COVID-19 was spread by people unaware that they were infected (so-called asymptomatic cases). This is unlikely to happen with monkeypox.

The more concerning risk wouldn’t be a direct outbreak, but rather a situation where the virus jumps from humans to livestock or pets and then back to humans and so on, in a ping-pong type of transmission. The risk to pets is thought to be extremely low currently, but the risk involving livestock (and especially pigs) is significantly higher.

Not a sex disease

Another unusual aspect of this outbreak is that many of these cases can be traced to two superspreader events that likely involved a lot of sex. In addition, a relatively large number of patients have reported genital lesions, which has prompted some reports of monkeypox behaving like a sex disease, or a “gay disease”.

But monkeypox most likely spreads via close skin-to-skin contact, which doesn’t necessarily involve sex. This is not the same as an STI. While a relatively large number of cases have been discovered in gay or bisexual men, Mateo Prochazka, an epidemiologist from the UK Health Security Agency (UKHSA), told the BBC:

“The infections are not about sexuality. We are concerned about monkeypox in general, as a public threat. We are worried about everyone’s health.”

It’s unclear why so many cases were reported in men that have sex with other men, but one reason could be that there are relatively few cases, and these cases could be owed to two superspreader events that were more likely to be attended by gay men: one is the Paraiso sauna, a gay-friendly establishment in the heart of Madrid, and another is Darklands Festival is a four-day event which encourages visitors to “explore their sexuality and develop a safe and sane interest for the many fetishes in our community”. However, this is still unclear and officials are still trying to do contact tracing to obtain a fine-grain image of how the disease is spreading and see where cases come from.

For now, authorities and researchers aren’t warning people to change their behavior, but rather to remain “hyper-vigilant.” The prospect of another pandemic is small, but with the COVID-19 pandemic still unfolding and with so many fresh and painful memories, we’ll want to keep a close eye on this one.