Abstract
Sexual transmission of Ebola virus (EBOV) is well established and has been implicated in multiple resurgences during the West African Ebola epidemic. Given the persistence of viral RNA in semen, guidelines from the World Health Organization (WHO) recommend abstinence or condom use for at least 1 year or until two semen PCR tests are negative. To better understand the impact of semen testing on sexual behavior, male EVD survivors were surveyed regarding their sexual behavior before and after semen testing. Of the 171 men who enrolled, 148 reported being sexually active following discharge from an ETU with 59% reporting episodes of condomless sex. At least one semen sample for testing was provided by 149 men and 13 of these men had EBOV RNA detected in their semen. When comparing sexual behaviors before and after semen testing, a positive semen test result had limited impact on behavior. Of those with seminal EBOV RNA detected, 61% reported no change in behavior pre- and post-semen testing with 46% engaging in condomless sex before and after testing and only 1 adopted safer sex behaviors following receipt of a positive result. Similarly, among men with undetectable EBOV in their semen, 66% reported no change in sexual behaviors with semen testing, with 55% forgoing condoms during sex. In only 11% was a negative semen result followed by abandoning condoms. There were no known sexual transmission events of Ebola virus in this cohort despite viral presence in semen during periods of condomless sex. This highlights the need to better understand the infectious potential of viral RNA persistence and determine what constitutes effective counseling for survivors and their partners.
Highlights
The development of acute Ebola Virus Disease (EVD) among female sexual partners of male EVD survivors and the persistence of detectable Ebola virus (EBOV) RNA in semen demonstrate the potential of Ebola as a sexually transmitted infection (STI)[1,2,3,4] which has important implications for infection control both during and following outbreaks of this virus
In the midst of the Ebola epidemic in West Africa, the World Health Organization (WHO) issued guidance for the prevention of sexual transmission of Ebola and recommended semen testing for male survivors beginning three months after recovery and continuing monthly while engaging in safe sexual practices with condom use or abstinence from sex until semen testing is negative on two consecutive occasions[5]
Subsequently reported data suggest EBOV RNA can persist in the semen of some survivors beyond 12 months[6], with viral RNA detected more than two years following recovery in a small number of EVD survivors[7]
Summary
The development of acute Ebola Virus Disease (EVD) among female sexual partners of male EVD survivors and the persistence of detectable Ebola virus (EBOV) RNA in semen demonstrate the potential of Ebola as a sexually transmitted infection (STI)[1,2,3,4] which has important implications for infection control both during and following outbreaks of this virus.In the midst of the Ebola epidemic in West Africa, the World Health Organization (WHO) issued guidance for the prevention of sexual transmission of Ebola and recommended semen testing for male survivors beginning three months after recovery and continuing monthly while engaging in safe sexual practices with condom use or abstinence from sex until semen testing is negative on two consecutive occasions[5]. Subsequently reported data suggest EBOV RNA can persist in the semen of some survivors beyond 12 months[6], with viral RNA detected more than two years following recovery in a small number of EVD survivors[7]. Intermittent detection of EBOV RNA in the semen has been reported, including a positive test following two negative tests, potentially complicating current WHO recommendations[7]. This study examines the sexual behavior of male EVD survivors in Liberia enrolled in a longitudinal cohort in which men over the age of 18 were invited to have semen tested for the presence of EBOV RNA to determine the impact of EBOV semen testing on sexual practices
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