Monkeypox is spreading in Texas. Here’s what you need to know about causes, symptoms and treatment.

The virus has been endemic in parts of Africa for decades but rarely makes it outside that continent. The first time it did, in 2003, the outbreak had Texas roots.

Some 70 people across the U.S. caught monkeypox from infected pet prairie dogs that had been imported through a Texas company and housed near rodents from Ghana.

In addition to the humans who are infected, the virus can also be found in rodents and nonhuman primates in Africa — but world health officials say there is still uncertainty over the natural origins of monkeypox.

The virus has been reported outside that continent only a handful of times, often in single cases, almost always through travelers. The U.S. Centers for Disease Control and Prevention is monitoring the current outbreak.

While most cases, particularly in the current outbreak, are not severe, monkeypox is nothing to ignore, said Dr. Jason Bowling, epidemiologist at University Health in San Antonio.

It causes painful, pus-filled blisters and lesions on the skin, along with fever and swollen lymph nodes in the early stages of infection. It can last from a few days to a month. And that can put someone in isolation for weeks to avoid spreading it, which can disrupt working and child care.

The virus is occasionally confused with chickenpox, herpes or syphilis due to the nature and location of the lesions.

Monkeypox is not considered a sexually transmitted infection because it is not transmitted exclusively through sex. It is most easily spread through contact with the lesions that are caused by the virus. Because skin-to-skin contact occurs during sex, it often is passed along during sexual activity.

But it can also travel through respiratory droplets while kissing. And it can be contracted by touching surfaces, clothing and bedding contaminated by secretions from an infected person or the fluid or scab tissue from lesions.

The virus is considered to be contagious when symptoms show up until the scabs fall off of lesions and new skin grows.

Because monkeypox is not an STI, it is not prevented reliably with condoms or abstinence. It is not, however, an airborne disease and is difficult to pass to others through casual contact.

The current cases, so far, have mostly been related to the type of contact that occurs during sex and are among people who have had sexual encounters, according to experts.

Casual contact like handshakes and even sharing food can carry the possibility of transmission, but the risk and chances of that happening are extremely low and are not the cause of the cases in the current outbreak, said Dr. Jennifer Shuford, chief state epidemiologist.

Health officials are advising men who have sex with men to take extra precautions because, so far, that is who has almost exclusively been impacted. But anyone can be infected, and experts believe the virus is likely to increasingly spread beyond that demographic.

Treatment specifically for the virus has been approved only experimentally, which means it requires extra paperwork and time to obtain. CDC officials say they are working to make it easier for clinics to prescribe treatment more quickly. For now, most medical response to the virus is managing pain and treating symptoms. A vaccine for monkeypox can also prevent or lessen symptoms up to 14 days after exposure.

There is a vaccine for monkeypox, but there hadn’t been enough Texas cases as of late July to garner a big enough federal allotment for the state to be able to give it to everyone at high risk of exposure, state officials say. The same is true in other states across the country, many of which are struggling to expand eligibility in spite of low supply.

The new vaccine for monkeypox, known as JYNNEOS, is effective in preventing infection in a person before they are exposed.

The CDC recommends prioritizing those with known exposures followed by people at high risk of being exposed, if supplies are there.

Texas health officials say that local health departments can request what they need directly from the federal government’s stockpile earmarked for Texas and get it typically within a day, even if they haven’t identified every case they’ll use it for yet, said Chris Van Deusen, spokesperson for the Texas Department of State Health Services.

While early allocations have led to only about 3,000 doses earmarked for Texas, Van Deusen said in late July that some 20,000 doses are expected to be available within weeks. The CDC is also working on increasing its stockpile but has said it could take months before the vaccine is widely available.

Monkeypox is not an airborne virus, so it is not as easy to contract as COVID-19 and cannot easily be passed through casual skin contact or regular familial contact. State health officials say the risk to most people is still very low.

Doctors and officials say that clinics will likely be strained if large numbers of patients need outpatient care for pain or symptoms — but they aren’t concerned about it reaching the same level of virulent transmission, loss of life or extensive crush on the health care system caused by COVID-19.