Priyanga Jayakumar, M.D., Rajashekar Reddy Yeruva, M.D., Steven Lippmann, M.D.

Following zika epidemics in 2015, this virus infection became an issue of preventing transmission and eradication. A global threat, it induces serious congenital abnormalities and neurological diseases (1). Since this viral is sexually transmitted, there are behavioral means to prevent zika transmission.

Male-to-female sexually transmitted cases are reported (1). Female-to-male and male-to-male sexual transmission of zika virus are also documented (2,3). In those cases, the saliva, serum, vaginal fluid, cervical mucus, genital or endocervical swabs, and semen contained a high viral load (1-3).Detection is by reverse transcriptase polymerase chain reactions (1-4). Zika remains present in semen for at least over three months, even after the saliva, serum, and urine are zika-negative (5).
 
There is a reported case of oral-sex transmission (4). The index case experienced zika-like symptoms following vaginal sex without ejaculation and oral sex with ejaculation. Both partners were later diagnosed with zika; virus concentrations were observed in semen, but not in saliva or serum (4).

The Centers for Disease Control and Prevention has guidelines to prevent sexual transmission (6). Women with zika virus infection or having been in zika-infested areas must wait at least eight weeks before engaging in any sexual relations or becoming pregnant. Men must avoid all sexual contacts for at least six months after symptom onset or even if just in an area with zika present (6). All sexual contacts should be avoided during pregnancy. Condoms may provide some protection. All possibly affected persons and those having been in zika endemic regions should be informed. These guidelines have changed in the past and may again change with longer clinical experience.
 
Zika virus transmission through fertility treatment is not documented, yet disease spread by donated gametes or embryos is possible (6). Do not utilize donated sperm, oocytes, and/or embryos for six months from confirmed zika-infected persons, those who were in areas of zika infestation, or anyone having sex with a partner who had contracted zika (6).

Because of the dangerous sequellae of zika infection during pregnancy, it is important for everyone to be aware of the risk for its transmission by sexual contacts. Physicians should impart this information to their at-risk patients.

REFERENCES

1.    Peterson LR, Jamieson DJ, Powers AM, et al. Zika virus. N Engl J Med. 2016; 374(16):1442-1463.  
2.    Deckard DT, Chung WM, Brooks JT, et al. Male-to-Male Sexual Transmission of Zika Virus – Texas, January 2016. MMWR (Morb Mortal Wkly Rep). 2016; 64(14):372-374.  
3.     Davidson A, Slavinski S, Komoto K, et al. Suspected Female-to-Male Sexual Transmission of Zika Virus — New York City, 2016. MMWR (Morb Mortal Wkly Rep). 2016; 65(28): 716-717.
4.    The author. The New York Times. Zika May Be Transmitted by Oral Sex, Scientists Find. June 2, 2016.
5.    Mansuya JM, Pasquiera C, Daudin M, et al. Zika virus in semen of a patient returning from a non-epidemic area. Lancet Infect Dis. 2016;16(8):894-895.
6.    Petersen EE, Polen KN, Meaney-Delman D, et al.  Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure – United States, 2016. MMWR (Morb Mortal Wkly Rep). 2016; 64(12): 314-322.