A total of 120 confirmed or suspected cases have been reported worldwide, including 20 in the UK, with most infections in Spain related to the sauna in Madrid. The World Health Organization has reported that there are another 28 suspicious cases in addition to 92 confirmed in 12 member countries that are not endemic for the virus.

The global figure is unprecedented for a disease commonly found in central and West Africa.

Smallpox is not easy to spread among humans, so doctors were baffled by the outbreak and the occurrence of cases on different continents simultaneously.

The virus is transmitted from person to person only through close physical contact, including sexual contact.

David Hayman, an infectious disease specialist at the World Health Organization, said he thought smallpox had hit the population as a “sexual form”.

He said: “It seems to be happening now that it has entered the population as a sexual form, as a genital form, and is spreading like sexually transmitted infections, which has intensified its transmission around the world.”

The president of the British Association for Sexual Health and HIV (BASHH) told Sky News that some clinic staff had received a smallpox vaccine that could be effective against monkeypox, and talks were under way to introduce doses to “potential risk groups”.

Dr Claire Duisnep said: “Our response here is really critical.

“There will be more diagnoses next week. It is difficult to say how much.

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Dr Dyusnap said she was concerned about the impact on other infections as staff were distracted from fighting monkeypox when “the health budget has dropped significantly over the last 10 years”.

She said: “In some clinics where there were cases, people had to be advised not to go.

“First and foremost, they did it because if someone has symptoms that correspond to smallpox, we don’t want people sitting in waiting rooms that potentially infect other people.

“They introduced telephone sorting in all of these places.”

The UK Health Agency said a significant proportion of recent cases in the UK and Europe have been found in gay and bisexual men.


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