Abstract
ObjectiveTo prospectively monitor Zika viral loads in semen from Belgian travellers with confirmed Zika virus infection, who returned from the Americas during the 2016 Zika virus epidemic.MethodsWe recruited symptomatic travellers consulting our clinic and we confirmed infection with either reverse-transcriptase (RT) polymerase chain reaction (PCR) assay or virus neutralization test. The participants produced semen samples weekly, either at the clinic or at home. For the initial sample, the laboratory staff did a microscopy analysis if they received the sample within an hour of production. Using RT–PCR, we monitored Zika virus ribonucleic acid (RNA) loads in semen until we obtained two negative results.FindingsWe detected Zika virus RNA in nine of 15 participants’ semen, one of whom was vasectomized. The median time to loss of RNA detection in semen was 83 days after symptom onset (95% confidence interval, CI: 57−108). The longest duration of viral shedding in semen before obtaining the first negative RT–PCR result was 144 days after symptom onset. All of the 11 participants, for whom we microscopically analysed their semen, had presence of leukocytes, 10 showed haematospermia and six showed oligospermia. These abnormalities occurred irrespective of Zika virus detection in semen.ConclusionThe majority of men in our study had detectable Zika virus RNA in their semen. We recommend that semen from Zika virus-infected men should be analysed with RT–PCR and that health professionals should advise infected men, even if they are vasectomized, about current recommendations for prevention of sexual transmission of the virus.
Highlights
Zika virus infection in humans may result in a mild disease characterized by rash, fever, arthralgia and conjunctivitis.[1,2]
We present the results from a cohort study that prospectively monitored viral loads in semen from Belgian travellers with confirmed Zika virus infection returning from the Americas
The Weibull distribution curve showed that the median loss of ribonucleic acid (RNA) detection in semen occurred at 83 days after symptom onset
Summary
Zika virus infection in humans may result in a mild disease characterized by rash, fever, arthralgia and conjunctivitis.[1,2] since its introduction in the Americas in 2015, the Zika virus has been found to cause congenital brain abnormalities and Guillain–Barré syndrome.[3]. The Zika virus, which belongs to the genus Flavivirus, is primarily transmitted by Aedes mosquitoes in endemic areas, but the virus can be transmitted from person-to-person via sexual encounter.[6] Evidence exists that people who had not resided in or travelled to areas with arthropod-borne Zika virus transmission have developed the disease after oral, vaginal or anal sexual intercourse with Zika virus infected partners.[6,7,8] Sexual transmission by asymptomatic men has been reported in a couple seeking assisted reproduction treatment and in a woman with a travelling male sex partner.[9,10] The longest documented interval between a man’s onset of symptoms and sexual transmission to a woman is 44 days.[11]
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