TAMPA, Fla. (WFLA) — As of the end of May, the U.S. Centers for Disease Control and Prevention has detected a monkeypox outbreak in nine states. The outbreak was officially designated on May 17, with the Massachusetts Department of Public Health confirming the presence from a resident, according to a CDC report.

Monkeypox, clinically known as orthopox, is a disease related to smallpox—or variola—though monkeypox is typically less severe, according to previous reporting by The Hill. There are multiple types of orthopoxviruses, according to information from the CDC.

Additional tests performed by the CDC on May 18 confirmed the patient in Massachusetts had been infected with “the West African clade of Monkeypox virus.” CDC reports said the patient in Massachusetts first presented symptoms on May 4. Similarly, a patient in New York City was also evaluated for monkeypox, with monkeypox confirmed there on May 19.

Nine states in the U.S. have confirmed cases since then. In total, 17 cases have been detected. The CDC said most cases, 16 of the 17 so far confirmed, were “diagnosed in persons who identify as gay, bisexual, or men who have sex with men.”

“Fourteen patients of the 17 patients reported international travel involving 11 different countries during the 21 days preceding symptom onset,” the CDC reported. The agency said all patients had rash onset dates from May 1 to May 27.

The virus has spread to Europe, Israel, Australia, and North America, including the United States. A case of monkeypox was detected in Los Angeles, Calif. on Thursday, though described as presumptive. Cases were detected on May 7 in the United Kingdom.

Near the end of May, the CDC confirmed nine cases of monkeypox in the U.S. in seven states. Florida was included in those locations. The Associated Press reported more than 100 cases of monkeypox were reported as of May 24. Reports suggested the current outbreak was “likely spread after sexual activity at two recent raves in Europe,” in Spain and Belgium, according to the World Health Organization.

“Stigma and discrimination in public health results in decreased access to care, ongoing disease transmission and a blunted response to outbreaks and threats,” CDC director Dr. Rochelle Walensky said. “So I urge everyone to approach this outbreak without stigma and without discrimination.”

On May 17, the CDC initiated a Health Alert Network Health Advisory to develop a response to the outbreak and set guidelines for partner health organizations to handle the virus. A call center for diagnosing the virus was set up on May 19.

The CDC’s latest report on monkeypox said person-to-person community transmission was how the virus was spreading.

“The CDC urges health departments, clinicians, and the public to remain vigilant, institute appropriate infection prevention and control measures, and notify public health authorities of suspected cases to reduce disease spread,” the health agency said. “Public health authorities are identifying cases and conducting investigations to determine possible sources and prevent further spread.”

Symptoms of monkeypox include fevers, chills, rashes, headaches, muscle aches, back aches, exhaustion, and lymphadenopathy or swelling of lymph nodes.

“Contact investigation is ongoing; among the 13 patients who have identified contacts, there are 56 high-, 117 intermediate-, and 235 low- or uncertain-risk contacts,” the CDC reported. “Contacts are recommended to be monitored for signs and symptoms consistent with monkeypox.”

Monkeypox belongs to the orthopox family of viruses. According to the CDC, 20 cases of monkeypox or orthopoxvirus have been detected in the United States, in 11 states.

In the notes on the monkeypox and orthopoxvirus global map, “Confirmed cases include those confirmed as monkeypox virus and may include cases only confirmed as orthopoxvirus.”

The report issued Friday afternoon on monkeypox was narrowed to focus on the monkeypox virus, alone.