The state Department of Health on Friday said it has identified an additional probable case of monkeypox in an Oahu resident, bringing the number of cases in Hawaii to five confirmed and one probable.

DOH said it received the orthopoxvirus results late Thursday night and that it has also identified connections between all six people but did not elaborate.

The risk to most Hawaii residents remains low, according to health officials, but anyone who has monkeypox symptoms or thinks they have been in contact with someone with it should contact their health care provider.

“The thing to bear in mind is the risk to most Hawaii residents remains very low,” said DOH Director Dr. Elizabeth Char on the Honolulu Star-Advertiser’s “Spotlight Hawaii” livestream program Friday. “It’s not something you’re going to get walking down the street or anything. This is a pretty rare virus that people are getting when they are in close physical contact or prolonged contact with somebody who’s infected. So this is more of an intimate contact sort of transmission. And so I think, bear in mind, the risk to the average person in Hawaii is quite low.”

Char said the department has a team that is aggressively contact tracing every case, which has found other people who may be at risk and uncovered subsequent cases.

“If we catch it early enough, people who are at very high risk, we could vaccinate,” she said. “People who are showing symptoms could be treated if it was appropriate.”

DOH reported the first probable case June 3 in an adult resident who was hospitalized at Tripler Army Medical Center. That resident had recently traveled to an area with confirmed cases. On June 8, DOH reported a second probable case in an adult resident who came into close contact with the first.

Then on June 9, the agency reported a third probable case of monkeypox in an adult resident who had no travel history and, at the time, no known connection to the first two cases. In mid-June, DOH identified two more probable cases of monkeypox and said all five were connected.

The Centers for Disease Control and Prevention has confirmed all five of those cases were monkeypox. Samples from the sixth probable case have been sent to CDC for confirmation.

Health officials describe monkeypox as a rare disease caused by the monkeypox virus, which is spread through direct contact with body fluids, lesions or bedding and clothing used by someone with monkeypox.

The monkeypox virus, which is part of the same family of viruses as smallpox, can also be spread through large respiratory droplets, but these droplets generally cannot travel more than a few feet so prolonged face-to-face contact is required, DOH said.

Infection begins with flu-like symptoms such as fever, headache, muscle aches, chills, exhaustion and swollen lymph nodes. Infection progresses to a rash or sores, often on the hands, feet, chest, face or genitals. Individuals generally become ill within 21 days of exposure.

Monkeypox can be spread from the time symptoms start until all sores have healed and a fresh layer of skin has formed, according to the CDC, which can take several weeks.

Nationwide, monkeypox cases have been disproportionately reported among gay or bisexual men, according to DOH. In Hawaii, at least some of the cases have been reported among gay or bisexual men.

However, DOH said, anyone who has close contact with someone with monkeypox is at risk of infection, regardless of sexual orientation or gender identity. Officials reminded members of the community to respond “with an inclusive, fact-based approach” when discussing monkeypox.

“Stigma is unacceptable and can drive people away from seeking healthcare serv­ices,” said DOH in a news release.

The CDC as of Friday listed 201 monkeypox and orthopoxvirus cases in 25 states, including Hawaii, and the District of Columbia.