The Journal of New England Medicine published the first major peer-reviewed study of monkeypox on Thursday, reviewing 528 officially diagnosed infections between April 27 and June 24 across 16 countries.

The study found that 98% of those infected were gay or bisexual men, and transmission of the zoonotic virus was “suspected to have occurred through sexual activity in 95% of the persons with infection.”

The Journal of New England Medicine study also found that the virus has an incubation period between three and 20 days, typically incubating in a host for about a week.

According to the Centers for Disease Control and Prevention (CDC), monkeypox was first discovered in 1958 within a colony of monkeys kept for research. Monkeypox is part of the same family of viruses that causes smallpox and is spread most often through skin-to-skin contact, including sexual contact, hugging, kissing, or even exposure to bedding, towels, and sex toys used by an infected person.

The first known human case was recorded in 1970, and for decades the virus has remained relatively rare outside of Africa. However, the virus exploded onto the world stage in 2022, with nearly 17,000 confirmed cases across the globe currently.

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In 2003 the United States experienced a so-called “outbreak” of monkeypox, with a total of 47 confirmed and probable cases reported from six states. CDC data from the current global outbreak shows nearly 3,000 confirmed cases in the United States as of the writing of this article.

The CDC’s Frequently Asked Questions page for the virus states, “Currently, this outbreak is largely affecting gay, bisexual, or other men who have sex with men.” But it is unknown how many people visit that page.

Former Trump administration health researcher and official Dr. Paul Alexander has criticized the agency for playing “political games” with communication about who is at the highest risk and who is spreading the virus.

In a series of blog posts, Alexander has accused the CDC of playing “political correctness woke games.”

He asked, “Why not tell the high-risk group what their risk is and what they must do urgently?”

For example, Alexander said, “All this needed was leadership saying, ‘No skin to skin contact, no anal sex, no sex, none for a few weeks,’ and we would have helped this high-risk group, but no, it’s political games. And now the low-risk, general, heterosexual population is at risk, especially from bisexual males.”

Some health experts have expressed concerns surrounding the spread of monkeypox during June LGBT Pride Month events, as reported by NBC News. While specific instances of monkeypox spreading during Pride events have been reported, the CDC does not publish monthly case numbers for a clearer picture of the impact of similar events nationwide.

The Dallas Express investigated news articles over that time to try to ascertain the outbreak’s growth. NBC News reported that as of June 23, there were only 173 confirmed cases of monkeypox in the United States. With the current confirmed case count hovering around 3,000, the virus has exponentially exploded nationwide in the last month.