Nineteen people in New York City have tested positive for presumed monkeypox, the city’s Department of Health and Mental Hygiene announced Thursday.

“The monkeypox virus is most often spread through direct contact with a rash or sores of someone who has the virus,” health officials tweeted.

The Health Department said the current cases are primarily spreading among men who have sex with men —​putting this group at greater risk of exposure.

Monkeypox is often spread through direct contact with a rash or sores of someone who has the virus, as well as through contact with clothing or bedding for that has been used by someone infected with the virus, the city said.

According to DOHMH, early symptoms for monkeypox may include fever, headache, muscle aches, backache, swollen lymph nodes, chills, and exhaustion.