Abstract
Sexual transmission of ZIKV in nonendemic regions is a reality, and ZIKV RNA persists in semen longer than other body fluids. Semen shedding of ZIKV may occur ~6months with infectivity lasting >2months. ZIKV eludes host cell antiviral or RNA interference (RNAi) pathways, and viral particles cross the blood-testis barrier to create persistent infections within seminiferous tubules—immune-privileged sites where postmeiotic germ cells are shielded from systemic immune attack. Sexual transmission of ZIKV likely causes more fetal illness than vector-spread disease, contributes to general infection rates, and impedes development of effective vaccines due to its survival in immune-advantaged locations.
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