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Monkeypox is an orthodox virus, the same branch of the huge pox virus family as smallpox (variola) and its 'vaccinia' vaccine. Of the remaining extant, wild orthodox viruses monkeypox historically comes closest to mimicking smallpox in humans. Not surprising as the host for which its named is more closely related to humans, than those for which the other orthodox viruses were named. Although it can cause as severe a human infection as smallpox it usually is significantly milder. The only certain way to differentiate it from smallpox is via DNA analysis. Although the rash of 'chickenpox' (varicella), an unrelated, non-pox virus in spite of its common name, is the rash most apt to be confused with smallpox by non-experts, in theory monkeypox can't be distinguished from smallpox with certainty on clinical grounds alone. The ability to prove a diagnosis of chickenpox is widespread. I suspect the US ability to 'prove' a diagnosis of monkeypox vs. smallpox only exists at the CDC, tied to the deal under which only our CDC and one Russian lab were allowed to keep smallpox for research. Which, alas, may aid the spread of some conspiracy theories.

Although 'MSM' subculture has long been known medically for having more infectious disease problems than 'straights' I wasn't aware of any of the orthodox viruses being known for spread as a STD. The most commonly seen 'human' pox virus, molluscum contagiosum, can be a STD, in both straight and gay populations, and can become widespread on the skin in AIDS, but is mostly seen as a self resolving mild skin only disease in children. And it's not very closely related to the orthodox viruses. So these reports that monkeypox is spreading in the gay community surprises me more than if it were spreading in a more general population. Which could result from more folks fleeing conflict in the Congo or from more immigrated West African's bringing along some of their culture and its consequences. The first touted monkeypox outbreak in the US was in a farm family in Wisconsin, who'd gotten it from a pet prairie dog, which they'd gotten from an exotic animal dealer who'd imported monkeypox infected Gambian Giant Rats—a delicacy in some cultures—which rats had then infected the prairie dog.