Men who have sex with men are at greater risk of contracting monkeypox than women. Many more cases of the disease may have been missed, according to the first ever study of women who had contracted the disease.

In the case series, it was found that sexual contact was the most common cause of infections among trans women. Only 61 percent of the cases that were connected to sexual contact were connected to cis gender women.

A researcher at Queen Mary University of London said that a quarter ofcis gender women in the study might have been exposed to an HIV-positive person without having sex. The women were believed to have been exposed to the disease through their jobs or homes.

Everyone needs to know about this. She said that public health messages have mostly been directed at men who have sex with men.

After several months of rapidly escalating case numbers, the monkeypox outbreak in the United States has slowed thanks in part to a vaccine campaign and changes in the behavior of many high risk individuals. There have been more than 29,000 cases in the United States since May.

Scientists are beginning to understand when and how the disease can be spread and who is at risk.

The new study suggests that the monkeypox virus can be transmitted through the vagina. The virus was found in seminal fluid in some studies.

The public health authorities argue that the monkeypox can be spread through close physical contact.

The fact that monkeypox can be transmitted in other ways should not prevent it from being classified as a sexually transmitted disease.

The Centers for Disease Control and Prevention has not made any changes to their list of sexually transmitted infections despite New York State adding monkeypox to it last month. The categorization will be left to individual states by the agency. It's clear that sexual behavior drives cases.

Would we have had a monkeypox outbreak if you had taken sex away? He said that it's probably not. It is definitely a sexually associated transmission even if the primary reason is skin-to-skin contact.

ImageA masked woman in a lab coat stands behind the window of a large testing unit lit with blue.
Morgan Verrett, a Renegade Bio Lab Assistant, processed monkeypox samples collected in San Francisco. Credit...Mike Kai Chen for The New York Times
A masked woman in a lab coat stands behind the window of a large testing unit lit with blue.

The international collaboration was led by Dr. Orkin. Britain, the United States and other countries are refining their definitions of the disease.

A study published last month by the U.K. Health Security Agency suggests that between 40 and 60 percent of monkeypox transmission can occur before a person develops symptoms.

Tom Ward, an infectious disease modeler for the agency, said that patients wouldn't have sex if they developed blisters. He said that a small percentage of people may never get sick.

It is difficult to trace contacts in a monkeypox outbreak because there are no tests that can detect the disease before the rash appears.

There is still a lot of research that needs to be done on the nature of monkeypox transmission.

Mild symptoms like a sore throat can be a sign of a rash.

Those people should stay out of harms way. He said that the public health message isn't changed by the chance of pre-symptomatic spread.

If there is past history that makes you think that you are at risk for monkeypox, it is important to get a vaccine.

The study is the first to describe monkeypox in a group of people who have little access to quality health care.

Sex and gender differences are important, and in some cases, they intersect.

In the study, researchers from 15 countries contributed clinical information from 69 cisgender women, 62 trans women and five non-binary individuals who were diagnosed with monkeypox between May 11 and October 4. A majority of the women were Latino, white and Black.

ImageMen stand in line in front of masked medical workers under blue pop-up tent in a park.
A makeshift monkeypox vaccination clinic in Manhattan this summer.Credit...Andrew Seng for The New York Times
Men stand in line in front of masked medical workers under blue pop-up tent in a park.

The study found that more than half of the patients had sores in their anus, genitals, mouth or eyes. cis gender women were initially misdiagnosed with other STDs.

According to experts, monkeypox might have a slightly different pattern of transmission depending on social behaviors and norms.

That was supported by the new study. Male monkeypox patients who have sex with men are more likely to attend a Pride event than the patients who don't. The cis gender women had one sexual partner in the previous month, and 7 percent of the cis gender women did not have a sexual partner in the previous month.

The driver was different.

Many of the trans women in the study had other risk factors for monkeypox, such as homelessness and injection drug use. Half of the trans women in the study had H.I.V., and more than half of the trans women were engaged in commercial sex work.

Even though the absolute number of people who are trans and engaged in sex work may not be very large, the extremely high prevalence of H.I.V. and now monkeypox means that public health agencies need to be thinking of ways to do outreach in this population.

The study found that the cis gender women went to primary care providers or to the emergency departments if they had monkeypox symptoms. Some cis gender women were never diagnosed with a disease.

It is likely that infections have been missed and not picked up.

Only two cases of monkeypox were identified among the cis gender women who lived with children. The C.D.C.'s observations jive with that finding.

The stigma associated with monkeypox may make it hard to report cases in children. There are more studies that need to be done to understand how the virus can cause different symptoms in different people.